6ER-045 Effectiveness and safety of first-line chemoimmunotherapy with pembrolizumab for metastatic non-squamous non-small-cell lung cancer
Year: 2025
Type: conference-paper
Study design: Observational Study
Abstract: Background and Importance Lung carcinoma is the leading cause of cancer-related death in the world. Pembrolizumab is a human IgG4 monoclonal antibody that binds to the PD-1, enhancing the immune response of T-cells. Aim and Objectives To evaluate effectiveness and safety of chemoimmunotherapy with pembrolizumab for metastatic non-squamous non-small-cell lung cancer (NSQ-NSCLC), without driver mutations EGFR/ALK. Secondary endpoint was to evaluate the impact of different variables on overall survival (OS). Material and Methods Retrospective observational study including all patients with metastatic NSQ-NSCLC who received platinum-based chemotherapy and pembrolizumab from January 2018 to July 2024. Data collected: histology, smoking, ECOG, metastasis, PD-L1 expression, chemotherapy, frequency and severity of adverse events (AEs), and treatment discontinuation due to AEs. Effectiveness was evaluated by median OS, progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR), calculated with Kaplan-Meier estimator, STATA v.16.0. Multivariate analysis was performed by Cox regression, expressed as hazard ratio (HR). Results Eighty-eight patients (69% men) with a median age of 65 years (RIC:56–70) were included. Histology: adenocarcinoma (89%), undifferentiated (8%), large cell carcinoma (2%) and mixed (1%). The 91% were ex-/smokers, with a median Pack-Year-Index of 40 (RIC:25–50); and 65% had ECOG 0–1. The 53% presented bone, 29% brain and 18% liver metastasis. The 50% had PD-L1<1%, negative or not-performed, 33% 1–49% and 17% PD-L1≥50%. The 91% received carboplatin vs 9% cisplatin. ORR was 56% (9% complete response) and DCR was 69%. Median OS and PFS were 10.6 months 95% CI (7.7–13.8) and 5 months 95% CI (4.3–7.7), respectively. One-year and 5 year OS rate were 46% and 13%, and 1 year and 5 year PFS were 21% and 12%, respectively. Ninety-nine percent experienced AEs: asthenia (57%), anaemia (28%), neutropenia (26%) and infection (24%). 47% suffered grade 3–4 AEs, mainly asthenia (22%). 17% discontinued treatment due to AEs. Regarding multivariate analysis, statistically significant variables were: ex-/smoker 5.0 (95% CI: 1.5–17); p=0.01; bone metastasis 2.6 (95% CI: 1.4–4.9); p=0.004; brain metastasis 1.9 (95% CI: 1.06–3.6); p=0.033 and ECOG 0–1 0.39 (95% CI: 0.21–0.72); p=0.003. Conclusion and Relevance More than half of the patients responded to treatment, however only a small part were alive or free from disease 5 years later. Smoking, bone and brain metastasis were associated with less survival. Most patients experienced AEs that caused discontinuation of therapy, which emphasises the need to adequately select patients. References and/or Acknowledgements Conflict of Interest No conflict of interest
Institution: Hospital Universitario de Guadalajara
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4408376295