Programmed Cell Death-Ligand 1 Expression and Clinical Outcomes Among Patients with Resected, Early-Stage Non-Small
Parneet K Cheema1,2, Iqra Syed3, Femida Gwadry-Sridhar4
1William Osler Health System, University of Toronto, 2100 Bovaird Drive, Brampton, ON L6R 3J7, Canada.
Abstract:
Treatment options for non-small cell lung cancer (NSCLC) are evolving, given recent and expected approvals of immune checkpoint inhibitors (ICIs) targeting programmed cell death-(ligand) 1 (PD-1/PD-L1). We retrospectively evaluated outcomes among patients with resected stage IB-IIIA NSCLC tumors expressing PD-L1 using PALEOS (Pan-cAnadian Lung cancEr Observational Study) data (2016-2019). Key outcomes included PD-L1 expression rate and treatment patterns, recurrence, and median overall (mOS) and disease-free survival (mDFS) among PD-L1+ patients. Among 539 PD-L1-tested patients, 317 (58.8%) were PD-L1+ (≥1%). At diagnosis, 35.3%, 39.8%, and 24.9% of PD-L1+ patients had stage IB, II, or IIIA disease. Forty-one percent had received adjuvant therapy. At 22.6 months (median follow-up), first disease recurrence had occurred in 31.9% of patients, primarily at metastatic sites. After first metastatic recurrence, ICI regimens were the most common first systemic therapy (29.8%). mOS was not reached; mDFS was 40.0 months. At four years, DFS probability was 44%. Four-year OS and DFS rates were generally similar when stratified by PD-L1 expression (1-49% vs. ≥50%). These findings underscore the generally poor outcomes experienced by patients with early-stage, resected, PD-L1+ NSCLC after treatment with available adjuvant therapies, and provide context to recent and emerging trials of new treatment options.
Insights
Outcomes for resected, early-stage non-small cell lung cancer (NSCLC) with PD-L1 expression remain poor despite adjuvant therapies. Immune checkpoint inhibitors (ICIs) are a common treatment after recurrence.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Research
Background:
- Treatment options for non-small cell lung cancer (NSCLC) are rapidly evolving.
- Immune checkpoint inhibitors (ICIs) targeting programmed cell death-(ligand) 1 (PD-1/PD-L1) are increasingly important in NSCLC management.
Purpose of the Study:
- To evaluate outcomes in patients with resected stage IB-IIIA NSCLC tumors expressing PD-L1.
- To analyze PD-L1 expression rates, treatment patterns, recurrence, and survival in PD-L1 positive NSCLC patients.
Main Methods:
- Retrospective analysis of the Pan-Canadian Lung cancer Observational Study (PALEOS) data from 2016-2019.
- Inclusion of patients with resected stage IB-IIIA NSCLC who were tested for PD-L1 expression.
Main Results:
- Of 539 PD-L1 tested patients, 58.8% were PD-L1 positive (≥1%).
- 31.9% of patients experienced disease recurrence, primarily at metastatic sites.
- Median disease-free survival (mDFS) was 40.0 months; 4-year DFS probability was 44%.
Conclusions:
- Patients with early-stage, resected, PD-L1+ NSCLC often have poor outcomes post-adjuvant therapy.
- Immune checkpoint inhibitor (ICI) regimens are the most frequent first systemic therapy after metastatic recurrence.
- Findings provide context for ongoing and future trials of novel treatment strategies in NSCLC.
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