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Sonam Ansel
Author of
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-38 - Real World Experience of 1st Line Pembrolizumab in Patients with Metastatic Non-Small Cell Lung Cancer (NSCLC) (Now Available) (ID 90)
08:00 - 18:00 | Author(s): Sonam Ansel
- Abstract
Background
In July 2017, Pembrolizumab, a Programmed Cell Death protein-1 (PD-1) inhibitor was approved in Scotland for first-line treatment of metastatic NSCLC in patients with tumours expressing PD-L1 with tumour proportion score (TPS) of ≥50% and no targetable genetic alterations. Approval was based on findings of the KEYNOTE-024 study. We investigated the survival and toxicities experienced by patients receiving Pembrolizumab in the West of Scotland.
Method
We identified patients with tumours expressing PD-L1 at TPS ≥ 50% from pathology records from August 2017 to August 2018 and subsequently identified 83 patients receiving first-line Pembrolizumab. We collected baseline and treatment characteristics using electronic patient records. Survival was estimated using the Kaplan Meier method.
Result
Baseline and treatment characteristics are shown in table 1. Thirty patients had pre-treatment CT head and 8 of them had untreated brain metastases, this would have prohibited KEYNOTE-024 trial entry. Furthermore, there were 10 patients (12%) with active autoimmune co-morbidities which would have been excluded from the trial.
After 9.4 months median follow-up, 32 (38.6%) patients had died. Survival at 6 months was 69.6% (95% CI: 58.3 to 78.3%) and 57.1% (95% CI: 42.1 to 69.6%) at 12 months.
39 patients (47%) experienced treatment toxicities, 15 (18.1%) experienced ≥ 2 toxicities. Diarrhoea was commonest (14 patients; 16.9%) followed by hypothyroidism (8 patients; 9.6%), pneumonitis (6 patients; 7.2%) and rash (5 patients; 6%).
Table 1: baseline and treatment characteristics n=83 Median age (range)
68 years (range: 39-86 years) Gender
Male: 42 (51%) Female: 41 (49%) Stage of disease
Stage 4
- untreated brain metastases*
Stage 3
68 (81.9%)
- 8 (11.8%)
15 (18.1%)
Histology
Adenocarcinoma
Squamous carcinoma
Undifferentiated NSCLC
Other histology54 (65.1%)
17 (20.5%)
9 (10.8%)
3 (3.6%)Performance status
0
1
212 (14.5%)
69 (83.1%)
2 (2.4%)Active autoimmune
co-morbidities*
Psoriasis
Interstitial lung disease
Fibromyalgia
Raynauds phenomenon
Rheumatoid arthritis
Post-polio syndrome
Multiple sclerosis3 (3.6%)
2 (2.4%)
1 (1.2%)
1 (1.2%)
1 (1.2%)
1 (1.2%)
1 (1.2%)Median number of cycles = 6 (range: 1-24); 31 patients (37.3%) still continuing treatment** Reason for discontinuing
treatment (n=52; 62.7%)
Poor PS
Disease progression
Treatment toxicity:
- Colitis
- Pneumonitis
Death:
- NSCLC
- Unknown cause
Patient choice19 (22.9%)
14 (16.9%)
10 (12%)
- 7 (8.4%)
- 3 (3.6%)
7 (8.4%)
- 5 (6%)
- 2 (2.4%)
2 (2.4%)*These patients would have been ineligible for KEYNOTE-024 trial
** At time of data analysis - 21 February 2019
Conclusion
Survival at 6 months for our cohort was less than in the KEYNOTE-024 study (69.6% vs 80.2%) however fewer patients were PS 0 (14.5% vs 35.1%) and several had co-morbidities which would have precluded trial entry. The median number of treatment cycles in our cohort was 6 (range: 1-24) vs 10.5 (range: 1 to 26) trial. Toxicity was more common in this real life cohort with 12% discontinuing treatment due to toxicity vs 7.1% in the pivotal trial.
