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Efficacy and safety of Pembrolizumab plus chemotherapy to Pembrolizumab monotherapy: a consecutive analysis of NSCLC patients with high PD-L1 expression


There has been an only indirect comparison between Pembrolizumab ( Keytruda ) and Pembrolizumab plus chemotherapy in patients with non-small cell lung cancer ( NSCLC ) and high programmed death-ligand 1 ( PD-L1 ) expression ( tumor proportion score [ TPS ] greater than or equal to 50% ).

Researchers have compared the efficacy and safety of these treatments.

The efficacy and safety of the 1st line ICI-containing regimen between December 2017 and December 2019, were consecutively reviewed.
The patients were divided into the immune checkpoint inhibitor ( ICI ) with chemotherapy group ( the ICI-combo group ) and the ICI monotherapy group ( the ICI-mono group ).
Propensity score matching ( PSM ) was applied at a ratio of 1:1.

Of 450 advanced NSCLC patients who underwent 1st line treatment, 130 with PD-L1 TPS greater than or equal to 50% treated by an ICI-containing regimen.
Forty-eight were classified as the ICI-mono group, 30 into the ICI-combo group.
The median follow-up months was 6.0 months ( 0.5-11.9 ) in the ICI-combo group and 12.4 months ( 0.4-18.6 ) in the ICI-mono group.
The backgrounds of patients, age and performance status ( PS ) were almost similar.

An overall response rate ( ORR ) of the ICI-combo group was relatively higher than that of the ICI-mono group ( 76.9% vs. 55.8% ).

The median progression-free survival ( mPFS ) in the ICI-combo group was relatively longer in the ICI-mono group ( 10.5 months vs. 7.0 months; hazard ratio [ HR ], 0.44; 95% confidence interval [ CI ], 0.18 to 1.06 ).
This trend was also observed under PSM, HR 0.40 ( 95% CI, 0.13 to 1.19 ).

At the time of analysis, the median overall survival had not been reached.

Frequency of all adverse events and immune-related serious adverse events (irAE) of Grade 3 or higher were similar in both groups.

In conclusion, although overall survival result was immature, it was suggested that ICI-combo might have better short-term outcomes than ICI-mono. ( Xagena )

Source: European Society for Medical Oncology ( ESMO ) Virtual Meeting, 2020

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