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

This study analyzed the comparative effectiveness of immune-checkpoint inhibitor (ICI) monotherapy versus ICI+chemotherapy (CIT) in the first-line (1L) setting among metastatic NSCLC (mNSCLC) patients with ≥ 50% programmed death-ligand 1 (PD-L1) expression, and without epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and c-ros oncogene 1 (ROS1) alterations.

Patients were identified from COTA's real-world (rw) database meeting the criteria: aged ≥ 18 years at diagnosis with mNSCLC on or after January 1, 2017, ≥ 50% PD-L1 expression, negative for EGFR, ALK, and ROS1 mutations, and received 1L ICI monotherapy or CIT. Characteristics and treatment patterns were summarized overall and by treatment group. Rw time to next treatment (rwTTNT), progression-free survival (rwPFS), and overall survival (rwOS) were summarized using Kaplan-Meier methodology. The inverse probability of treatment weighting method was used to balance baseline characteristics for adjusted analyses.

Of 311 patients, 178 received ICI monotherapy and 133 received CIT. Adjusted median rwTTNT was 11.31 months for the CIT group compared to 7.63 for the ICI group (HR: 0.68, 95% CI: 0.50, 0.93). Adjusted rwPFS for the CIT group vs. ICI group was 8.78 and 5.56 months, respectively (HR: 0.82, 95% CI: 0.61, 1.11), and adjusted median rwOS for CIT and ICI was 23.08 and 20.28 months, respectively (HR: 0.83, 95% CI: 0.59, 1.18).

Although adjusted rwTTNT differed by treatment group, this did not translate to a significant difference in survival. Among mNSCLC patients with high PD-L1 expression, the addition of chemotherapy to ICI did not improve survival.