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Heidi A.I. Grosjean



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    P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Health Services Research/Health Economics
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P09.08 - Age-Related Outcomes of First-Line Pembrolizumab in a Real-World Non-Small-Cell Lung Cancer (NSCLC) Cohort (ID 3451)

      00:00 - 00:00  |  Presenting Author(s): Heidi A.I. Grosjean

      • Abstract
      • Slides

      Introduction

      On the basis of the KEYNOTE-024 trial, pembrolizumab became standard of care in Canada for patients with PD-L1 positive (≥50%) NSCLC. However, robust real-world data assessing outcomes in this treatment setting, especially amongst patients of different age groups, are lacking. The primary objective of this study was to examine age-related outcomes in a real-world cohort of NSCLC patients treated with pembrolizumab.

      Methods

      Patients who initiated first-line, single-agent pembrolizumab for treatment of PD-L1-positive (≥50%) NSCLC in Alberta, Canada from 3/1/2017 to 12/30/2019 were included. Data cutoff date was 05/01/2020. Patient demographics and clinical outcomes were collected retrospectively. The primary outcome was median overall survival (mOS) among age-stratified groups. Secondary outcomes were median time-to-treatment failure (mTTF) and objective response rate (ORR). Kaplan-Meier survival curves were used to determine survival outcomes, and compared with the log-rank test. A Cox-proportional hazard model was constructed with relevant clinical characteristics to assess their impact on survival.

      Results

      Of the 327 patients included in the analysis, 31% (n=101) were <65 years old, 45% (n=147) were between 65-74 years old and 24% (n=79) were ≥75 years old. mOS (95% CI) was 12.3 mo (8.3-17.5) for the entire cohort. Stratified by age, mOS between the groups were not significantly different (15.4 mo [6.0-23.8], 9.3 mo [6.8-16.5], and 14.4 mo [8.2-23.2] for the <65, 65-74, and ≥75 age groups, respectively; p=0.81). In addition, neither the mTTF nor ORR differed between age groups (p=0.59 and p=0.86, respectively). All three groups had similar 90-day mortality rates after treatment initiation; 29.7%, 23.8%, and 17.7% (p=0.18) and similar survival at 12 months (39.6%, 32.7%, and 31.6%, p=0.43).

      In a multivariate model accounting for sex, age, tumor histology, baseline autoimmune disease, presence of brain metastases, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS), only ECOG-PS ≥ 2 was an independent prognosticator of poor survival (HR 2.9; 95% CI 2.1-4.0, P < 0.0001).

      Table 1. Clinical outcomes as stratified by age

      <65 Cohort (n=101)

      65-74 Cohort (n=147)

      75 Cohort (n=79)

      p-value

      mOS (95% CI)

      15.4 (6.0-23.8)

      9.3 (6.8-16.5)

      14.4 (8.2-23.2)

      0.81a

      mTTF (95% CI)

      4.5 (2.1-5.5)

      3.7 (2.8-4.9)

      5.6 (2.8-7.7)

      0.59a
      %ORR^ 29.6% 32.5% 33.9% 0.86b
      % alive at 90 d 70.3% 76.2% 82.3% 0.18b
      % alive at 12 mo 39.6% 32.7% 31.6% 0.43b

      ^Calculated from evaluable responses. alog-rank test. bchi-squared test.

      Conclusion

      There were no significant differences in mOS, mTTF, or ORR between the age-stratified treatment groups in our sample. Notably, we observed a ~25% mortality rate within the first 90-days of treatment initiation, and a mOS of only 12.3 mo. ECOG-PS ≥ 2 was the only significant prognosticator of poor OS. Although we conclude that age alone should not be a contraindication to treatment with first-line pembrolizumab in PD-L1-positive NSCLC, survival outcomes are modest compared to the KEYNOTE-024 trial, with poor ECOG-PS being the strongest negative prognostic factor.

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