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Real-World Effectiveness of Immunotherapy Among Patients With Pre-treated, Advanced NSCLC
Though the overall survival (OS) benefits of immunotherapy (IO) observed in real-world studies among pre-treated patients with advanced non-small cell lung cancer (NSCLC) are consistent with clinical trials, they vary for vulnerable patient groups, who are often excluded from trials (Lung Cancer. 2022;166:205-220. doi:10.1016/j.lungcan.2022.03.008).
“We aimed to summarize the existing real-world evidence on the survival outcomes of IO in second- or higher line in advanced NSCLC,” wrote Ariadna Juarez-Garcia, PhD, Bristol Myers Squibb, Uxbridge, UK, and colleagues.
Authors performed a systematic review of 66 real-world observational studies that reported OS estimates with IO, primarily nivolumab, pembrolizumab or atezolizumab, in adult, pre-treated advanced or recurrent NSCLC patients. Random-effect models were used to perform meta-analysis, pooling 1- and 2-year OS rates across studies. Patients treated with IO were examined, including the elderly, those with poor performance status (PS) and those exhibiting metastasis. Among the studies selected for this systematic review, 70% (46) included a nivolumab-specific study arm.
Results from the random-effect model on pooled 1-year OS rates with nivolumab monotherapy were 45.6% (95% CI; 43.4–47.8), and 28% (95% CI; 24.8–31.4) for 2-year OS. Among the mixed immune checkpoint inhibitors (ICI) group, the pooled 1-year OS rates were 43.9% (95% Cl; 39.1–48.8), and 20.4% (95% CI; 14.7–27.6) for 2-year OS. OS rates with nivolumab were slightly higher in non-elderly patients compared to elderly patients. Worse survival rates were observed in patients with poor PS. The pooled one-year OS estimate was 27.1% in PS ≥2 vs 51.6% in PS <2. The pooled 2-year OS rate with nivolumab in patients with brain metastases was 22.1%, and 26.1% in patients without brain metastases. This difference was significant in 36% of individual studies.
“While the OS benefits of IO seen in real-world studies among pre-treated, advanced NSCLC patients are consistent with pivotal clinical trials, these tend to vary for the more vulnerable patient groups, such as patients with poor PS, which are often excluded from trials,” concluded Dr Juarez Garcia and colleagues.
