Patients with advanced non-small cell lung cancer (NSCLC) who undergo salvage chemotherapy are 30% more likely to achieve partial response if they have been treated with a PD-1/PD-L1 checkpoint inhibitor, according to a presentation at the European Lung Cancer Conference (Geneva, Switzerland; abstract 91PD).
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PD-1/PD-L1 inhibitors are considered second-line standard-of-care for patients with NSCLC after chemotherapy and front-line therapy for those with high PD-L1 expression. However, some patients do not respond to immune checkpoint inhibitors and progress after treatment. For such patients, conventional chemotherapy may offer a more active therapy approach.
Sacha Rothschild, MD, PhD, department of medicine, division of oncology, University Hospital Basel (Switzerland), and colleagues conducted a retrospective analysis to evaluate the effects of conventional chemotherapy after initial immunotherapy failed to slow the progression of advanced NSCLC. The study analyzed 82 patients with various types of stage IV NSCLC, including adenocarcinoma (n = 63), squamous cell carcinoma (n = 18), and large cell carcinoma (n = 1). Sixty-seven of the patients had been previously treated with PD-1/PD-L1 inhibitors and all patients had been pre-treated with at least 1 chemotherapy regimen. Patients who had not been treated with immune checkpoint inhibitors (n = 15) served as a control group.
Researchers administered salvage chemotherapy to all patients, including docetaxel (62%), pemetrexed (20%), paclitaxel (6%), and others (12%). Computed tomography scans were performed within the first month of salvage chemotherapy initiation, followed by every 6 weeks.
Results of the scans showed a significantly higher partial response rate for the patients in the PD-1/PD-L1 cohort compared with those in the control cohort (27% vs 7%, OR, 0.3; P < .0001). Stable disease was reported in 51% of patients in the PD-1/PD-L1 cohort and 53% of the control cohort. Progressive disease was reported in 22% of the PD-1/PD-L1 cohort and 40% in the control cohort.
Multiple logistic regression showed no factors that may have contributed to the likelihood of achieving partial response.
"Our results are of utmost importance for [patients with NSCLC]," said Dr Rothschild in a press release (May 3, 2017). “These results are good news for patients that progress after immunotherapy and are still fit enough to receive further palliative therapy." — Zachary Bessette
