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Shinkichi Takamori
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P75 - Immunotherapy (Phase II/III Trials) - Misc. Topics (ID 248)
- Event: WCLC 2020
- Type: Posters
- Track: Immunotherapy (Phase II/III Trials)
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P75.06 - Survival Benefit From Immunocheckpoint Inhibitors in Stage IV Non-Small Cell Lung Cancer Patients With Brain Metastases (ID 3379)
00:00 - 00:00 | Presenting Author(s): Shinkichi Takamori
- Abstract
Introduction
Immunocheckpoint inhibitors (ICIs) have become a standard pharmacological therapy in non-small cell lung cancer (NSCLC). Because brain metastases (BMs) have historically been listed as exclusion criteria in previous clinical trials involving ICIs in advanced NSCLC, the survival benefit from ICI in NSCLC patients with BMs remains unclear.
Methods
The National Cancer Database was queried for stage IV NSCLC patients with or without BMs between 2014 and 2015. Overall survival (OS) of stage IV NSCLC patients who received immunotherapy and that of stage IV NSCLC patients who did not receive immunotherapy were compared according to the presence or absence of BMs. Multivariable logistic analyses identified the clinical characteristics predictive of overall survival. A propensity score analysis was conducted with the aim of adjusting the potential biases arising from the clinical characteristics.
Results
This study included 42,512 patients with stage IV NSCLC; 11,810 patients with BMs and 30,702 patients without BMs. In univariate analysis, stage IV NSCLC patients with BMs treated with immunotherapy had a significantly longer OS than those without immunotherapy after propensity score matching (median OS: 12.8 vs. 10.1 months, hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.72–0.89, P 0.0001; Figure). Multivariable Cox modeling after propensity score matching confirmed the survival benefit from ICI for stage IV NSCLC patients with BMs (HR: 0.75, 95% CI: 0.67–0.83, P 0.0001; Table). The HR in NSCLC patients without BMs treated with ICI compared with those without ICI was 0.77 (95% CI: 0.73–0.82, P 0.0001).
Table Factors
Before propensity score matching (n = 11,810)
After propensity score matching (n = 1,680)
Univariate
Multivariable
Univariate
Multivariable
HR (95% CI)
HR (95% CI)
HR (95% CI)
HR (95% CI)
P value
P value
P value
P value
Age
70
0.70 (0.67-0.73)
0.83 (0.80-0.87)
0.79 (0.69-0.90)
0.84 (0.74-0.96)
≥70
0.0001
0.0001
0.0005
0.0106
Sex
female
0.84 (0.81-0.87)
0.86 (0.83-0.89)
0.86 (0.77-0.96)
0.86 (0.77-0.96)
male
0.0001
0.0001
0.0074
0.0085
Race
others
0.85 (0.80-0.90)
0.85 (0.81-0.90)
0.72 (0.61-0.85)
0.77 (0.65-0.91)
whites
0.0001
0.0001
0.0001
0.0021
Insurance status
insured
1.02 (0.92-1.14)
1.00 (0.90-1.12)
0.87 (0.65-1.20)
0.90 (0.67-1.25)
uninsured
0.7003
0.9735
0.3704
0.5277
Institution
academic
0.80 (0.77-0.83)
0.82 (0.79-0.85)
0.82 (0.73-0.91)
0.80 (0.71-0.90)
others
0.0001
0.0001
0.0003
0.0001
Charlson-Deyo score
0-1
0.73 (0.69-0.78)
0.83 (0.78-0.88)
0.71 (0.59-0.86)
0.76 (0.63-0.93)
≥2
0.0001
0.0001
0.0006
0.0067
Year of diagnosis
2015
0.95 (0.91-0.99)
0.97 (0.93-1.01)
0.97 (0.87-1.08)
0.98 (0.88-1.10)
2014
0.0074
0.1533
0.5978
0.7533
Histology
adenocarcinoma NOS
0.78 (0.75-0.81)
0.81 (0.77-0.84)
0.79 (0.70-0.90)
0.82 (0.72-0.93)
others
0.0001
0.0001
0.0004
0.0029
Nodal status
N0
0.88 (0.84-0.92)
0.78 (0.75-0.82)
0.92 (0.80-1.05)
0.92 (0.80-1.06)
≥N1
0.0001
0.0001
0.2192
0.2503
Bone metastasis
no
0.81 (0.78-0.85)
0.79 (0.76-0.83)
0.74 (0.66-0.82)
0.76 (0.68-0.86)
yes
0.0001
0.0001
0.0001
0.0001
Liver metastasis
no
0.68 (0.66-0.70)
0.72 (0.69-0.77)
0.65 (0.56-0.76)
0.71 (0.61-0.83)
yes
0.0001
0.0001
0.0001
0.0001
Surgery for primary lesion
yes
0.47 (0.41-0.53)
0.51 (0.45-0.59)
0.62 (0.37-0.96)
0.64 (0.39-1.04)
no
0.0001
0.0001
0.0322
0.0744
Radiation
yes
0.75 (0.71-0.79)
0.98 (0.93-1.03)
0.97 (0.81-1.17)
1.01 (0.84-1.21)
no
0.0001
0.3724
0.7466
0.9217
Chemotherapy
yes
0.38 (0.36-0.39)
0.38 (0.36-0.39)
0.61 (0.51-0.73)
0.58 (0.48-0.70)
no
0.0001
0.0001
0.0001
0.0001
Immunotherapy
yes
0.62 (0.57-0.67)
0.70 (0.65-0.77)
0.80 (0.72-0.89)
0.75 (0.67-0.83)
no
0.0001
0.0001
0.0001
0.0001
Conclusion
Survival in stage IV NSCLC patients with BMs was significantly improved by ICI treatment at levels comparable to those without BMs. ICI is one of the promising treatment options for stage IV NSCLC patients with BMs. These findings should be validated in future prospective studies.
