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First-line pembrolizumab for metastatic NSCLC in lower-middle-income countries: bridging the efficacy-effectiveness
Ullas Batra1, Mansi Sharma1, Alexis Andrew Miller2
1Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India.
Introduction:
Pembrolizumab is a standard first-line therapy for advanced/metastatic non-small cell lung cancer (a/mNSCLC) lacking actionable mutations. Data from lower-middle-income countries (LMICs) remain scarce.
Methods:
From January 2019 to June 2024, we prospectively analyzed 78 a/mNSCLC patients receiving pembrolizumab-based first-line therapy. Endpoints included overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and conditional survival probabilities.
Results:
With a median follow-up of 27 months, median OS was 21 months (95% CI: 12.2-30.8) and median PFS 6.3 months (95% CI: 5.5-10.1). At first response evaluation (2 months), partial response was seen in 47.4% (37/78), stable disease in 16.7% (13/78). Next-generation sequencing (85% tested) revealed non-actionable mutations in 70%; notably, 4 of 6 long-term survivors harbored KRAS mutations. PD-L1 TPS ≥ 50% significantly lowered progression and mortality risk. Age, performance status (ECOG), and disease response significantly influenced the OS. The conditional survival probability for an additional 6 months after surviving the first 6 months was 78.1% (90% in patients with controlled disease).
Conclusion:
Real-world LMIC data demonstrated comparable effectiveness of pembrolizumab-based therapy in a/mNSCLC despite a higher proportion of adverse prognostic factors. More studies in diverse clinical settings are needed to provide a reliable estimate of benefit.
Insights
Pembrolizumab shows comparable effectiveness in advanced non-small cell lung cancer patients in lower-middle-income countries. Real-world data reveal survival benefits despite challenging prognostic factors.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Research
Background:
- Pembrolizumab is a standard first-line treatment for advanced/metastatic non-small cell lung cancer (a/mNSCLC) without actionable mutations.
- Limited real-world data exist for a/mNSCLC treatment outcomes in lower-middle-income countries (LMICs).
Purpose of the Study:
- To evaluate the real-world effectiveness of first-line pembrolizumab-based therapy in a/mNSCLC patients from LMICs.
- To assess overall survival (OS), progression-free survival (PFS), and disease control rate (DCR) in this population.
Main Methods:
- Prospective analysis of 78 a/mNSCLC patients receiving first-line pembrolizumab from January 2019 to June 2024.
- Assessment of survival endpoints, response rates, and conditional survival probabilities.
- Next-generation sequencing (NGS) was performed to identify mutations, with PD-L1 expression and ECOG status also analyzed.
Main Results:
- Median OS was 21 months and median PFS was 6.3 months with a median follow-up of 27 months.
- Partial response (47.4%) and stable disease (16.7%) were observed at 2 months.
- High PD-L1 expression (TPS ≥ 50%) correlated with reduced progression and mortality risk; KRAS mutations were noted in long-term survivors.
Conclusions:
- Pembrolizumab-based therapy demonstrates comparable efficacy in LMIC a/mNSCLC patients, even with a higher burden of adverse prognostic factors.
- Real-world data support its use, but further research in diverse settings is crucial for precise benefit estimation.
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