Early Progression in Non-Small Cell Lung Cancer (NSCLC) with High PD-L1 Treated with Pembrolizumab in First-Line Setting: A Prognostic Scoring System Based on Clinical Features
| Autor: | Ilaria Attili, Filippo de Marinis, Emilio Bria, Domenico Galetta, Alain Gelibter, Maria Lucia Reale, Diana Giannarelli, Valeria Stati, Pamela Pizzutilo, Alessio Stefani, Silvia Novello, Antonio Passaro, Simona Carnio, Emanuele Vita |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Oncology Cancer Research medicine.medical_specialty corticosteroid Multivariate analysis non-small cell lung cancer (NSCLC) Pembrolizumab Logistic regression NSCLC Article pleural metastasis detrimental effect 03 medical and health sciences 0302 clinical medicine Internal medicine medicine RC254-282 Performance status business.industry Area under the curve Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease 030104 developmental biology 030220 oncology & carcinogenesis Population study immunotherapy prognosis business Progressive disease |
| Zdroj: | Cancers, Vol 13, Iss 2935, p 2935 (2021) Cancers Volume 13 Issue 12 |
| ISSN: | 2072-6694 |
| Popis: | Background: Pembrolizumab is approved in monotherapy for the first-line (1L) of advanced or metastatic NSCLC patients with high PD-L1 (≥50%). Despite a proportion of patients achieve long-term survival, about one-third of patients experience detrimental survival outcomes, including early death, hyperprogression, and fast progression. The impact of clinical factors on early progression (EP) development has not been widely explored. Methods: We designed a retrospective, multicenter study involving five Italian centers, in patients with metastatic NSCLC with PD-L1 ≥ 50%, treated with Pembrolizumab in a 1L setting. EP was defined as a progressive disease within three months from pembrolizumab initiation. Baseline clinical factors of patients with and without EP were collected and analyzed. Logistic regression was performed to identify clinical factors associated with EP and an EP prognostic score was developed based on the logistic model. Results: Overall, 321 out of 336 NSCLC patients treated with 1L pembrolizumab provided all the data for the analysis. EP occurred in 137 (42.7%) patients the median PFS was 3.8 months (95% CI: 2.9–4.7), and median OS was not reached in the entire study population. Sex, Eastern Cooperative Oncology Group (ECOG) performance status (PS), steroids, metastatic sites ≥2, and the presence of liver/pleural metastasis were confirmed as independent factors for EP by multivariate analysis. By combining these factors, we developed an EP prognostic score ranging from 0–13, with three-risk group stratification: 0–2 (good prognosis), 3–6 (intermediate prognosis), and 7–13 (poor prognosis). The area under the curve (AUC) of the model was 0.76 (95% CI: 0.70–0.81). Conclusions: We identified six clinical factors independently associated with EP. We developed a prognostic score model for EP-risk to potentially improve clinical practice and patient selection for 1L pembrolizumab in NSCLC with high PD-L1, in the real-world clinical setting. |
| Databáze: | OpenAIRE |
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