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Immune checkpoint inhibitors in advanced non-small cell lung cancer: A metacentric experience from India
Santosh Kumar1, Srujana Joga2, Bivas Biswas3
1Department of Medical Oncology, Dr B.R.A. Institute-Rotary Cancer Hospital., All India Institute of Medical Sciences, New Delhi, India.
Background:
Immune check point inhibitors (ICIs) have changed the treatment paradigm of driver mutation negative non-small cell lung cancer (NSCLC) and they are increasingly incorporated in first-line treatment. Real-world experience of use of these drugs is limited. We aim to evaluate the real-world experience of use of ICIs in patients with advanced NSCLC.
Patients And Methods:
Medical records of patients with NSCLC treated with ICIs at 4 major academic cancer centers in India between January 2016 and December 2018 were analyzed. The type of ICI taken, response rates, survival, and toxicity profiles were analyzed.
Results:
The median age at presentation was 60 years (range: 27-79 years). Nivolumab was the most commonly used ICI drug [80%, n = 70] followed by pembrolizumab [10%, n = 9], and atezolizumab [10%, n = 9]. The median number of ICIs cycles received were 4 (range 2-65). Among the evaluable responses in 74 patients, the objective response rates was 25.6% and clinical benefit rate was 46%. Immune related toxicity occurred in 39.9% of patients but, severe toxicity of Grade III and Grade IV occurred in 5 (5.6%) patients. After a median follow-up time of 8.86 months (95%CI 5.2-11.1) the progression-free survival was 4.73 months (95%CI 3.7-8.9), and overall survival was 11.6 months (95%CI 7.33-NR). ECOG PS at the time of start of ICIs was found to be significant determinant of Progression-free survival and overall survival.
Conclusion:
Our study demonstrates the feasibility of usage of ICIs in advanced NSCLC in Indian setting with acceptable safety profile and comparable responses with the published studies.
Insights
Immune checkpoint inhibitors (ICIs) show feasibility in advanced non-small cell lung cancer (NSCLC) in India. Real-world data reveal acceptable safety and response rates comparable to global studies.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Research
Background:
- Immune checkpoint inhibitors (ICIs) have transformed driver mutation-negative non-small cell lung cancer (NSCLC) treatment.
- Their incorporation into first-line therapy necessitates real-world data, particularly in diverse settings like India.
Purpose of the Study:
- To evaluate the real-world experience of using ICIs in patients with advanced NSCLC in India.
- To assess response rates, survival outcomes, and toxicity profiles of ICIs in this population.
Main Methods:
- Retrospective analysis of medical records from 4 Indian academic cancer centers (Jan 2016-Dec 2018).
- Patients with advanced NSCLC treated with ICIs were included.
- Data on ICI type, response, survival, and toxicity were analyzed.
Main Results:
- Nivolumab was the most frequent ICI (80%).
- Objective response rate was 25.6%, with a clinical benefit rate of 46%.
- Immune-related toxicity occurred in 39.9% of patients, with severe toxicity (Grade III/IV) in 5.6%. Median overall survival was 11.6 months.
- ECOG Performance Status (PS) was a significant determinant of progression-free and overall survival.
Conclusions:
- ICIs are feasible for advanced NSCLC in the Indian setting.
- The safety profile and response rates are comparable to published international studies.
- Real-world data support the use of ICIs in Indian NSCLC patients.
