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Abbas MN, Klevansky M, Koczwara B, Roy AC, Sukumaran S, Vatandoust S, Karapetis CS. Real-world experience of nivolumab in the treatment of poor performance status patients with advanced non-small cell lung cancer. Cancer Rep (Hoboken) 2021; 5:e1487. [PMID: 34196124 PMCID: PMC8955060 DOI: 10.1002/cnr2.1487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nivolumab improves disease control and survival in advanced NSCLC in patients with good performance status (PS), but there is limited data on its efficacy in patients with poor PS. Aim Primary objective of the study was to evaluate the efficacy and safety of nivolumab and examine the influence of PS on outcomes. Methods and Results Retrospective analysis of patients treated with single‐agent nivolumab for advanced NSCLC at a single institution was performed. Sixty‐six patients treated with nivolumab were identified (33 male) with a median age of 68.5 years. Fifty‐six (85%) patients were current or former smokers and 17 (26%) had brain metastasis. All patients had received prior chemotherapy, 39 (59%) patients received one and 27 (41%) had ≥2 prior lines of therapy. Median overall survival (OS) was 7.1 months (95%CI 3.61–11.3) in the overall study population. OS of patients with PS ≥2 at the start of treatment was 3.04 months (95%CI 1.64–7.36) as compared to 10.23 months (95%CI 7.06–18.9) with PS ≤1. The overall response rate was 7% (four patients had a partial response), 23 (40%) patients had stable disease; the overall disease control rate (partial response and stable disease) was 47%. Twenty‐six (40%) patients had PS ≥2 at the start of treatment and 2 (8%) of these patients developed a partial response, 4 (15%) had stable disease; the overall disease control rate was 23%. Fourteen (58%) patients with PS ≥2 had disease progression at the time of first disease response evaluation. In the overall population, 20% of patients experienced grade ≥3 treatment‐related adverse events (TRAEs), most commonly pneumonitis, hepatitis, and colitis. Fourteen TRAEs led to treatment discontinuation, 9 (23%) adverse events (AEs) in patients with PS ≤1 and 5 (19%) with PS ≥2. Fourteen (21%) patients died within 30 days of the last nivolumab treatment. Conclusion There was no significant difference in toxicity leading to treatment discontinuation between the poor and good PS groups, but survival was shorter with poorer PS. PS appears to be an important prognostic factor and remains a relevant discriminator in the selection of treatment with immunotherapy for lung cancer.
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Affiliation(s)
- M Nazim Abbas
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Myron Klevansky
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amitesh Chandra Roy
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Shawgi Sukumaran
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sina Vatandoust
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Christos Stelios Karapetis
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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2
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Kocak MZ. Comment on 'Impact of performance status on non-small cell lung cancer patients with a PD-L1 tumour proportion score ≥50% treated with front-line pembrolizumab'. Acta Oncol 2021; 60:564-565. [PMID: 33612057 DOI: 10.1080/0284186x.2021.1889028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mehmet Zahid Kocak
- Medical Oncology Department, Necmettin Erbakan University, Meram, Konya, Turkey
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3
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Risk factors for skeletal-related events in non-small cell lung cancer patients treated with bone-modifying agents. Support Care Cancer 2021; 29:4081-4088. [PMID: 33404803 DOI: 10.1007/s00520-020-05880-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The risk factors for skeletal-related events (SREs) among non-small cell lung cancer (NSCLC) patients during treatment with bone-modifying agents (BMAs) are not yet well-understood. METHODS The medical records of 238 consecutive NSCLC patients treated with BMAs, including zoledronic acid and denosumab, at the Chiba University Hospital from 2012 to 2016 were reviewed in the present study. SREs were defined as either pathologic fractures, spinal cord compression, the need for bone irradiation or surgery, or hypercalcemia. The risk factors for earlier occurrence of the first SRE from the time of the first bone metastasis diagnosis after the initiation of BMA treatment were identified. RESULTS Of the 238 included patients, 92% (n = 220) had a performance status (PS) of 0-2 at diagnosis of bone metastasis. Forty-eight (20%) patients developed at least one SRE. The most common first SRE was the need for bone irradiation surgery (n = 27, 56%). Significant risk factors included poor PS (hazard ratio [HR]: 4.36; p = .024), male sex (HR: 2.17; p = .022), and the use of zoledronic acid (HR: 1.91; p = .032). The overall survival (OS) from the first bone metastasis diagnosis was 394 days (95% confidence interval [CI]: 331-465). The OS of patients with PS 3 and 4 at the diagnosis of bone metastasis (median: 36 days; 95% CI: 13-50) was significantly (p < 0.0001) shorter than that of patients with PS 0-2 (median: 411 days; 95% CI: 354-558) (HR: 4.53; 95% CI: 2.62-7.35). CONCLUSIONS Careful observation is needed for patients with the identified risk factors, which include poor PS and male sex, despite the BMA treatment.
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Friedlaender A, Metro G, Signorelli D, Gili A, Economopoulou P, Roila F, Banna G, De Toma A, Camerini A, Christopoulou A, Lo Russo G, Banini M, Galetta D, Jimenez B, Collazo-Lorduy A, Calles A, Baxevanos P, Linardou H, Kosmidis P, Mountzios G, Garassino MC, Addeo A. Impact of performance status on non-small-cell lung cancer patients with a PD-L1 tumour proportion score ≥50% treated with front-line pembrolizumab. Acta Oncol 2020; 59:1058-1063. [PMID: 32762415 DOI: 10.1080/0284186x.2020.1781249] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: We retrospectively analysed patients with advanced non-small-cell lung cancer (NSCLC) harbouring high PD-L1 expression (>50%) and treated with front-line pembrolizumab, comparing outcomes of patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to those with PS 0-1.Methods: Data were collected by 16 participating centres. All patients with NSCLC and high PD-L1, treated with first-line pembrolizumab were included. We collected medical data from patient files, pathology and laboratory reports. Patient characteristics, comorbidities, PS, and tumour characteristics were reported. Overall survival (OS), progression-free survival (PFS) and response rate (RR) were calculated.Results: 302 patients were included, 246 with PS 0-1, 56 with PS 2. RR was 72% among patients with PS 0-1 compared to 45% with PS2 (odds ratio (OR) 0.31 (95% CI: 0.17-0.57), p < .001). Median PFS was 2.6 months (95% CI: 1.9-5.1) among patients with PS2 and 11.3 months (95% CI: 8.5-14.4) among those with PS 0-1. Median OS was 7.8 months (95% CI: 2.5-10.7) in the PS2 group, not reached in the PS 0-1 group. PS 2 remained predictive of poor outcomes in multivariate analysis.Conclusion: PS 2 is a strong independent predictor of poor response and survival in NSCLC patients with high PD-L1, treated with front-line pembrolizumab. Prospective randomised trials comparing immunotherapy to chemotherapy in this population would be welcome.
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Affiliation(s)
- Alex Friedlaender
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Giulio Metro
- Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Alessio Gili
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Fausto Roila
- Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Alessandro De Toma
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Andrea Camerini
- U.O.C. Oncologia, Ospedale Versilia, Lido di Camaiore (LU), Italy
| | | | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Marco Banini
- Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Beatriz Jimenez
- Medical Oncology, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | | | - Antonio Calles
- Division of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Panagiotis Baxevanos
- Second Department of Medical Oncology, Saint Savvas Anti-Cancer Hospital, Athens, Greece
| | - Helena Linardou
- First Department of Medical Oncology, Metropolitan Hospital, Athens, Greece
| | - Paris Kosmidis
- Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Giannis Mountzios
- Second Department of Medical Oncology, Henry Dunant Hospital Center, Athens, Greece
| | - Marina C. Garassino
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Alfredo Addeo
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
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Gomes F, Wong M, Battisti NML, Kordbacheh T, Kiderlen M, Greystoke A, Luciani A. Immunotherapy in older patients with non-small cell lung cancer: Young International Society of Geriatric Oncology position paper. Br J Cancer 2020; 123:874-884. [PMID: 32694695 PMCID: PMC7492214 DOI: 10.1038/s41416-020-0986-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
Immunotherapy with checkpoint inhibitors against programmed cell death receptor (PD-1) and programmed cell death ligand (PD-L1) has been implemented in the treatment pathway of patients with non-small cell lung cancer (NSCLC) from locally advanced disease to the metastatic setting. This approach has resulted in improved survival and a more favourable toxicity profile when compared with chemotherapy. Following the successful introduction of single-agent immunotherapy, current clinical trials are focusing on combination treatments with chemotherapy or radiotherapy or even other immunotherapeutic agents. However, most of the data available from these trials are derived from, and therefore might be more applicable to younger and fitter patients rather than older and often frail lung cancer real-world patients. This article provides a detailed review of these immunotherapy agents with a focus on the data available regarding older NSCLC patients and makes recommendations to fill evidence gaps in this patient population.
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Affiliation(s)
- Fabio Gomes
- Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - Melisa Wong
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA
| | | | - Tiana Kordbacheh
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Mandy Kiderlen
- Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Alastair Greystoke
- Medical Oncology, Newcastle-upon-Tyne NHS Foundation trust, Newcastle, UK
| | - Andrea Luciani
- Medical Oncology, Ospedale S. Paolo University Hospital, Milan, Italy
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6
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Kasherman L, Siu DHW, Lee KWC, Lord S, Marschner I, Lewis CR, Friedlander M, Lee CK. Efficacy of immune checkpoint inhibitors in older adults with advanced stage cancers: A meta-analysis. J Geriatr Oncol 2020; 11:508-514. [DOI: 10.1016/j.jgo.2019.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 12/26/2022]
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7
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Berghmans T, Dingemans AM, Hendriks LEL, Cadranel J. Immunotherapy for nonsmall cell lung cancer: a new therapeutic algorithm. Eur Respir J 2020; 55:55/2/1901907. [PMID: 32029641 DOI: 10.1183/13993003.01907-2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Thierry Berghmans
- Thoracic Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Marie Dingemans
- Dept of Pulmonary Diseases GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Dept of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lizza E L Hendriks
- Dept of Pulmonary Diseases GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jacques Cadranel
- Service de Pneumologie, APHP, Hôpital Tenon and Sorbonne Université, Paris, France
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8
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La-Beck NM, Nguyen DT, Le AD, Alzghari SK, Trinh ST. Optimizing Patient Outcomes with PD-1/PD-L1 Immune Checkpoint Inhibitors for the First-Line Treatment of Advanced Non-Small Cell Lung Cancer. Pharmacotherapy 2020; 40:239-255. [PMID: 31930528 DOI: 10.1002/phar.2364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The rapidly expanding repertoire of immune checkpoint inhibitors (ICIs) now includes two agents, pembrolizumab and atezolizumab, approved for first-line treatment of advanced non-small cell lung cancer (aNSCLC) as monotherapy or as part of chemoimmunotherapy. This review summarizes the clinical evidence supporting these indications, with a focus on strategies to optimize patient outcomes. These strategies include patient and tumor factors, adverse-effect profiles, pharmacokinetic and pharmacodynamic drug interactions, and quality of life and cost-effectiveness considerations. We performed a systematic literature search of the PubMed, Scopus, and Google Scholar databases, as well as a search of the conference proceedings of the American Society of Clinical Oncology, European Society for Medical Oncology, and American Association for Cancer Research (through August 31, 2019). The addition of ICIs to conventional chemotherapy as first-line treatment against aNSCLC is now part of the standard of care options. However, even though ICIs may be cost-effective in patients with aNSCLC, high drug and other associated costs can still be a barrier to treatment for patients. Moreover, the adverse-effect profiles of ICIs differ significantly from conventional chemotherapy, and some immune-related adverse effects may have a lasting impact on quality of life. Therefore, in adhering to a patient-centered model of care, clinicians should be mindful of patient- and treatment-specific factors when considering therapeutic options for patients with aNSCLC. Although the role of the immune system in cancer progression and regression has not been fully elucidated, the full clinical potential of immunotherapeutics in the treatment of cancer likely remains to be unleashed.
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Affiliation(s)
- Ninh M La-Beck
- Department of Immunotherapeutics and Biotechnology, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas.,Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas
| | - Dung T Nguyen
- Department of Immunotherapeutics and Biotechnology, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas
| | - Alex D Le
- Department of Immunotherapeutics and Biotechnology, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas
| | - Saeed K Alzghari
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas.,Baylor Scott and White Medical Center, Waxahachie, Texas.,Department of Pharmacotherapy, University of North Texas Health Science Center College of Pharmacy, Fort Worth, Texas
| | - Saralinh T Trinh
- College of Pharmacy and Health Sciences, St. John's University, Queens, New York
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9
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Prelaj A, Ferrara R, Rebuzzi SE, Proto C, Signorelli D, Galli G, De Toma A, Randon G, Pagani F, Viscardi G, Brambilla M, Trevisan B, Ganzinelli M, Martinetti A, Gallucci R, Di Mauro RM, Molino G, Zilembo N, Torri V, de Braud FM, Garassino MC, Lo Russo G. EPSILoN: A Prognostic Score for Immunotherapy in Advanced Non-Small-Cell Lung Cancer: A Validation Cohort. Cancers (Basel) 2019; 11:E1954. [PMID: 31817541 PMCID: PMC6966664 DOI: 10.3390/cancers11121954] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Beyond programmed death ligand 1 (PD-L1), no other biomarkers for immunotherapy are used in daily practice. We previously created EPSILoN (Eastern Cooperative Oncology Group performance status (ECOG PS), smoking, liver metastases, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR)) score, a clinical/biochemical prognostic score, in 154 patients treated with second/further-line immunotherapy. This study's aim was to validate EPSILoN score in a different population group. METHODS 193 patients were included at National Cancer Institute of Milan (second-line immunotherapy, 61%; further-line immunotherapy, 39%). Clinical/laboratory parameters such as neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels were collected. Kaplan-Meier and Cox hazard methods were used for survival analysis. RESULTS Overall median progression-free survival and median overall survival were 2.3 and 7.6 months, respectively. Multivariate analyses for Progression-Free Survival (PFS) identified heavy smokers (hazard ratio (HR) 0.71, p = 0.036) and baseline LDH < 400 mg/dL (HR 0.66, p = 0.026) as independent positive factors and liver metastases (HR 1.48, p = 0.04) and NLR ≥ 4 (HR 1.49, p = 0.029) as negative prognostic factors. These five factors were included in the EPSILoN score which was able to stratify patients in three different prognostic groups, high, intermediate and low, with PFS of 6.0, 3.8 and 1.9 months, respectively (HR 1.94, p < 0.001); high, intermediate and low prognostic groups had overall survival (OS) of 24.5, 8.9 and 3.4 months, respectively (HR 2.40, p < 0.001). CONCLUSIONS EPSILoN, combining five baseline clinical/blood parameters (ECOG PS, smoking, liver metastases, LDH, NLR), may help to identify advanced non-small-cell lung cancer (aNSCLC) patients who most likely benefit from immune checkpoint inhibitors (ICIs).
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Affiliation(s)
- Arsela Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Roberto Ferrara
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Sara Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy;
| | - Claudia Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giulia Galli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Alessandro De Toma
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giovanni Randon
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Filippo Pagani
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giuseppe Viscardi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Benedetta Trevisan
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Monica Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Antonia Martinetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Rosaria Gallucci
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Rosa Maria Di Mauro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giuliano Molino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Nicoletta Zilembo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Valter Torri
- Pharmacological Research Institute IRCSS Mario Negri, Via La Masa 19, 20156 Milan, Italy;
| | - Filippo Maria de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Marina Chiara Garassino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
| | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (R.F.); (C.P.); (D.S.); (G.G.); (A.D.T.); (G.R.); (F.P.); (G.V.); (M.B.); (B.T.); (M.G.); (A.M.); (R.G.); (R.M.D.M.); (G.M.); (N.Z.); (F.M.d.B.); (M.C.G.); (G.L.R.)
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10
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Ksienski D, Wai ES, Croteau N, Freeman AT, Chan A, Fiorino L, Brooks EG, Poonja Z, Fenton D, Geller G, Irons S, Lesperance M. Pembrolizumab for advanced nonsmall cell lung cancer: Efficacy and safety in everyday clinical practice. Lung Cancer 2019; 133:110-116. [PMID: 31200816 DOI: 10.1016/j.lungcan.2019.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/26/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES While pembrolizumab improves overall survival (OS) in a subset of advanced nonsmall cell lung cancer (aNSCLC) patients (pts) in clinical trials, individuals with poor Eastern Cooperative Oncology Group performance status (ECOG PS) were excluded. Furthermore, some studies have identified a potential link between improved pt outcomes and development of immune related adverse events (irAE.) In a large provincial cohort, we studied the efficacy and safety of pembrolizumab for poor ECOG PS pts and whether irAE correlate with improved OS. MATERIALS AND METHODS aNSCLC pts treated with pembrolizumab between 06/2015 and 08/2018 at BC Cancer were retrospectively identified. Kaplan-Meier curves of OS from initiation of pembrolizumab were plotted. 3-, 6-, and 9- month landmark Kaplan-Meier analysis was performed and log-rank tests used to determine an association of irAE subtypes with OS. Multivariable logistic regression identified variables associated with grade ≥3 irAE within 3 months of pembrolizumab initiation. RESULTS Of 190 pts, 74.2% were treatment naïve and 92.6% had PD-L1 expression ≥ 50%. Median OS in the 1st line and ≥2nd line settings were 24.3 months (95% CI, 9.7-not reached, NR) and 13.4 months (95% CI, 8.1-NR), respectively. Pts with ECOG PS 2/3 had lower median OS than if ECOG PS 0/1 (5.8 months vs. 16.7 months, p < 0.0001). In multivariable analysis, the odds of grade ≥ 3 irAE within 3 months was 6.3 fold higher if ECOG PS 2/3 versus 0/1 (p = 0.05). Development of pneumonitis at the 9 month landmark weakly correlated with decreased OS (p = 0.09). CONCLUSION In the studied cohort, ECOG PS 2/3 pts had a significantly lower OS and greater odds of experiencing high-grade irAE than if ECOG PS 0/1. Development of irAE did not result in improved OS. Randomized trials to determine benefit of pembrolizumab for poor ECOG PS pts are needed.
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Affiliation(s)
| | | | | | | | | | | | | | - Zia Poonja
- BC Cancer- Victoria, British Columbia, Canada
| | | | | | - Sarah Irons
- BC Cancer- Victoria, British Columbia, Canada
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11
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From clinical trials to real-world practice: Immune checkpoint inhibitors in older adults. J Geriatr Oncol 2019; 10:384-388. [DOI: 10.1016/j.jgo.2019.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022]
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12
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Passaro A, Spitaleri G, Gyawali B, de Marinis F. Immunotherapy in Non-Small-Cell Lung Cancer Patients With Performance Status 2: Clinical Decision Making With Scant Evidence. J Clin Oncol 2019; 37:1863-1867. [PMID: 30995172 DOI: 10.1200/jco.18.02118] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | - Bishal Gyawali
- 2Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,3Queen's Cancer Research Institute, Kingston, Ontario, Canada
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