Treatment Patterns and Outcomes of Non-Small Cell Lung Cancer with High PD-L1 Expression using Real World Evidence.

Area of Science:

• Oncology
• Immunotherapy
• Clinical Trials

Background:

• First-line treatment for metastatic non-small cell lung cancer (mNSCLC) with high PD-L1 expression is evolving.
• Immune-checkpoint inhibitors (ICIs) have shown efficacy, but their combination with chemotherapy requires further investigation in specific patient populations.

Purpose of the Study:

• To compare the real-world effectiveness of ICI monotherapy versus ICI plus chemotherapy (CIT) in the first-line treatment of mNSCLC patients with PD-L1 expression ≥ 50% and no targetable mutations (EGFR, ALK, ROS1).

Main Methods:

• A real-world database was used to identify 311 mNSCLC patients meeting the inclusion criteria.
• Patients received either first-line ICI monotherapy or CIT.
• Outcomes including time to next treatment (rwTTNT), progression-free survival (rwPFS), and overall survival (rwOS) were analyzed using inverse probability of treatment weighting (IPTW) for adjusted comparisons.

Main Results:

• The CIT group (n=133) showed a longer adjusted median rwTTNT (11.31 months) compared to the ICI monotherapy group (n=178) (7.63 months).
• However, no significant differences were observed in adjusted median rwPFS (8.78 months for CIT vs. 5.56 months for ICI) or adjusted median rwOS (23.08 months for CIT vs. 20.28 months for ICI).

Conclusions:

• While CIT led to a longer time to next treatment, it did not translate into improved progression-free survival or overall survival compared to ICI monotherapy in this patient cohort.
• The addition of chemotherapy to ICIs does not appear to enhance survival outcomes for first-line mNSCLC patients with high PD-L1 expression and no targetable driver mutations.