Regimen Selection for Chemoimmunotherapy in Nonsquamous Non-Small Cell Lung Cancer with Low PD-L1 Expression: A...

Area of Science:

• Oncology
• Immunotherapy
• Pulmonology

Background:

• Chemoimmunotherapy is standard for advanced nonsquamous NSCLC with low PD-L1 expression.
• No direct comparisons exist between different immune checkpoint inhibitors (ICIs) in this patient group.
• This study addresses the need for evidence-based treatment guidance.

Purpose of the Study:

• To compare the efficacy and safety of different ICI-chemotherapy regimens.
• To guide treatment decisions for advanced nonsquamous NSCLC with PD-L1 expression between 1% and 49%.

Main Methods:

• Retrospective analysis of 316 patients with advanced nonsquamous NSCLC and PD-L1 TPS 1-49%.
• Patients received platinum-based chemotherapy combined with anti-PD-1, anti-PD-L1, or anti-PD-1/CTLA-4 antibodies.
• Comparison of survival outcomes and grade ≥3 adverse events.

Main Results:

• No significant differences in median overall survival (28.6 vs 23.1 vs 24.4 months) or progression-free survival (9.4 vs 7.2 vs 8.7 months) were observed.
• The anti-PD-1/CTLA-4/Chemo group had lower hematologic toxicity but higher non-hematologic toxicity.
• The anti-PD-L1/Chemo group showed a significantly lower incidence of grade ≥3 pneumonitis (P = .049).

Conclusions:

• Survival outcomes were comparable across the evaluated chemoimmunotherapy regimens.
• Adverse event profiles differed significantly among the treatment groups.
• Anti-PD-L1 antibody combination chemotherapy may be associated with a reduced risk of severe pneumonitis in this patient population.