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

To explore the efficacy and safety of immune checkpoint inhibitor (ICI) without pemetrexed as first-line maintenance therapy in driver-gene negative advanced lung adenocarcinoma.

A retrospective analysis was conducted on patients with advanced lung adenocarcinoma who were treated with pemetrexed and platinum combined with ICI as first-line therapy at PLA General Hospital from January 2019 to December 2023. Clinical data of the patients were collected and followed up. SPSS, GraphPad Prism and R were used to analyze the clinical characteristics and survival of the patients.

A total of 138 patients were included in this study, with a median follow-up time of 38.4 months. The median progression-free survival (PFS) of ICI maintenance group and pemetrexed plus ICI (P + ICI) maintenance group were 16.1 months (95%CI 13.9-18.2) and 11.5 months (95%CI 10.0-13.0). No statistically difference was observed between the 2 groups (P = .19). The median overall survival (OS) was 51.1 months (95% CI 32.5-69.6) for the ICI group and 43.6 months (30.4-56.8) for the P + ICI group, with no statistically difference (P = .55). The objective response rate (ORR) was 52.2% (95%CI 40.4-64.0) in the ICI group and 65.2% (95%CI 54.0-76.4) in the P + ICI group. Treatment-related adverse events (TRAEs) occurred in 91.3% and 92.8% of patients, respectively, while grade ≥ 3 events occurred in 27.5% and 30.4%. No grade 5 adverse reactions occurred.

The maintenance treatment of ICI without pemetrexed showed good therapeutic efficacy and manageable adverse events, which can be an option as the first-line maintenance therapy for patients with driver-gene negative advanced lung adenocarcinoma.