Immune Checkpoint Inhibitor Without Pemetrexed for First-line Maintenance Therapy in Advanced Lung Adenocarcinoma: A...

Area of Science:

• Oncology
• Immunotherapy
• Thoracic Medicine

Background:

• Advanced lung adenocarcinoma (LUAD) lacks driver gene mutations in a significant patient subset.
• First-line maintenance therapy aims to prolong survival and improve outcomes in advanced LUAD.
• Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, including LUAD.

Purpose of the Study:

• To evaluate the efficacy and safety of ICI monotherapy versus pemetrexed plus ICI as first-line maintenance in driver-gene negative advanced LUAD.
• To compare progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and treatment-related adverse events (TRAEs).

Main Methods:

• Retrospective analysis of 138 advanced LUAD patients treated with first-line pemetrexed and platinum combined with ICI.
• Patients received either ICI maintenance or pemetrexed plus ICI maintenance.
• Clinical data and survival outcomes were analyzed using SPSS, GraphPad Prism, and R.

Main Results:

• No statistically significant difference in PFS (16.1 vs. 11.5 months, P=.19) or OS (51.1 vs. 43.6 months, P=.55) between ICI maintenance and P + ICI groups.
• Objective response rates were 52.2% for ICI and 65.2% for P + ICI.
• High incidence of TRAEs (91.3% vs. 92.8%), with grade ≥3 events in 27.5% vs. 30.4%.

Conclusions:

• First-line maintenance with ICI monotherapy shows comparable efficacy to pemetrexed plus ICI in driver-gene negative advanced LUAD.
• ICI maintenance without pemetrexed is associated with manageable adverse events.
• This approach represents a potential first-line maintenance option for this patient population.