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Frost N, Kollmeier J, Misch D, et al. Pembrolizumab as First-Line Palliative Therapy in PD-L1 Overexpressing (≥ 50%) NSCLC: Real-world Results with Special Focus on PS ≥ 2, Brain Metastases, and Steroids. Clin Lung Cancer. 2021;22(5):411-422doi: 10.1016/j.cllc.2021.02.001.
Frost, N., Kollmeier, J., Misch, D., Vollbrecht, C., Grah, C., Matthes, B., Pultermann, D., Olive, E., Raspe, M., Ochsenreither, S., von Laffert, M., Suttorp, N., Witzenrath, M., & Grohé, C. (2021). Pembrolizumab as First-Line Palliative Therapy in PD-L1 Overexpressing (≥ 50%) NSCLC: Real-world Results with Special Focus on PS ≥ 2, Brain Metastases, and Steroids. Clinical lung cancer, 22(5), 411-422. https://doi.org/10.1016/j.cllc.2021.02.001
Frost, Nikolaj, et al. "Pembrolizumab as First-Line Palliative Therapy in PD-L1 Overexpressing (≥ 50%) NSCLC: Real-world Results with Special Focus on PS ≥ 2, Brain Metastases, and Steroids." Clinical lung cancer vol. 22,5 (2021): 411-422. doi: https://doi.org/10.1016/j.cllc.2021.02.001
Frost N, Kollmeier J, Misch D, Vollbrecht C, Grah C, Matthes B, Pultermann D, Olive E, Raspe M, Ochsenreither S, von Laffert M, Suttorp N, Witzenrath M, Grohé C. Pembrolizumab as First-Line Palliative Therapy in PD-L1 Overexpressing (≥ 50%) NSCLC: Real-world Results with Special Focus on PS ≥ 2, Brain Metastases, and Steroids. Clin Lung Cancer. 2021 Sep;22(5):411-422. doi: 10.1016/j.cllc.2021.02.001. Epub 2021 Feb 06. PMID: 33648877.
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Clin Lung Cancer. 2021 Sep;22(5):411-422. doi: 10.1016/j.cllc.2021.02.001. Epub 2021 Feb 06.

Pembrolizumab as First-Line Palliative Therapy in PD-L1 Overexpressing (≥ 50%) NSCLC: Real-world Results with Special Focus on PS ≥ 2, Brain Metastases, and Steroids.

Clinical lung cancer

Nikolaj Frost, Jens Kollmeier, Daniel Misch, Claudia Vollbrecht, Christian Grah, Burkhard Matthes, Dennis Pultermann, Elisabeth Olive, Matthias Raspe, Sebastian Ochsenreither, Maximilian von Laffert, Norbert Suttorp, Martin Witzenrath, Christian Grohé

Affiliations

  1. Department of Infectious Diseases and Pulmonary Medicine. Electronic address: [email protected].
  2. Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany.
  3. Department of Pathology.
  4. Department of Pneumonology, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
  5. Department of Infectious Diseases and Pulmonary Medicine.
  6. Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany.
  7. Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

PMID: 33648877 DOI: 10.1016/j.cllc.2021.02.001

Abstract

INTRODUCTION: Pembrolizumab is a highly effective standard of care in PD-L1 overexpressing (≥ 50%) non-small-cell lung cancer. However, a substantial share of patients from everyday clinical practice is treated without clear evidence from clinical trials.

PATIENTS AND METHODS: We performed a retrospective multicentric study including all consecutive patients from 6 certified lung cancer centers in Berlin, Germany, having received pembrolizumab as first-line palliative therapy from January 1 until December 31, 2017. Aims were to validate published clinical trials with a special focus on efficacy and outcome in patients with reduced performance status (PS), brain metastases, and steroids.

RESULTS: A total of 153 patients were included (median age 69 years, 58% men, 69% adenocarcinoma). Rates for PS ≥ 2, brain metastases, and steroids were 24.8%, 20.9%, and 24.2%, respectively. Median objective response rate, progression-free and overall survival were 48.5%, 8.2 and 22.0 months for all patients and 52.4%, 8.8 and 29.2 months in patients fulfilling the inclusion criteria for the KEYNOTE-024 trial. Patients with a comorbidity-defined PS ≥ 2, symptomatic brain metastases requiring upfront radiotherapy, or baseline steroids had significantly reduced survival. In contrast, durable responses occurred with a tumor-related PS ≥ 2 or asymptomatic brain metastases. Grade 3/4 and 5 immune-related adverse events affected 13.7% and 2.0% of patients.

CONCLUSION: Real-world and clinical trial efficacy with upfront pembrolizumab correspond well. Pembrolizumab may sufficiently control asymptomatic brain metastases and may improve a cancer-related reduced PS. However, the frail share of patients with a comorbidity-defined PS ≥ 2, symptomatic brain metastases, or baseline steroids derives no relevant benefit.

Copyright © 2021. Published by Elsevier Inc.

Keywords: Checkpoint inhibitors; Non–small-cell lung cancer; Real-world data; brain metastases; performance status

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