First-line Treatment Patterns and Outcomes in Advanced Non-Small Cell Lung Cancer in Sweden: A Population-based Real-world Study with Focus on Immunotherapy

Authors

  • Gunnar Wagenius Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Medical Unit Head and Neck, Lung, and Skin Tumors, Thoracic Oncology Center, Karolinska University Hospital, Stockholm, Sweden
  • Anders Vikström Department of Respiratory Medicine, Linköping University Hospital, Linköping, Sweden
  • Anders Berglund Epistat AB, Uppsala, Sweden
  • Stina Salomonsson MSD, Centre for Observational and Real-World Evidence, Stockholm, Sweden
  • Goran Bencina MSD, Centre of Observational Real-World Evidence, Madrid, Spain
  • Xiaohan Hu Merck & Co., Inc., Centre of Observational Real-World Evidence, Rahway, New Jersey, USA
  • Dana Chirovsky Merck & Co., Inc., Centre of Observational Real-World Evidence, Rahway, New Jersey, USA
  • Hans Brunnström Department of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Genetics, Pathology, and Molecular Diagnostics, Skåne University Hospital, Lund, Sweden

DOI:

https://doi.org/10.2340/1651-226X.2024.20309

Keywords:

non-small cell lung cancer, immunotherapy, real-world evidence, overall survival, PDL-1 testing

Abstract

Background and purpose: The treatment landscape for patients with advanced non-small cell lung cancer (NSCLC) has evolved significantly since the introduction of immunotherapies. We here describe PD-L1 testing rates, treatment patterns, and real-world outcomes for PD-(L)1 inhibitors in Sweden.

Materials and methods: Data were obtained from the Swedish National Lung Cancer Registry for patients with advanced NSCLC and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0–2 who initiated first-line ­systemic treatment from 01 April 2017 to 30 June 2020. PD-L1 testing was available in the registry from 01 January 2018. Kaplan-Meier was used for overall survival (OS) by type treatment and histology.

Results: A total of 2,204 patients with pathologically confirmed unresectable stage IIIB/C or IV NSCLC initiated first-line treatment, 1,807 (82%) with nonsquamous (NSQ) and 397 (18%) with SQ. Eighty-six per cent (NSQ) or 85% (SQ) had been tested for PD-L1 expression, a proportion that increased over time. The use of platinum-based therapy as first-line treatment decreased substantially over time while there was an upward trend for PD-(L)1-based therapy. Among patients with PS 0–1 initiating a first-line PD-(L)1 inhibitor monotherapy, the median OS was 18.6 and 13.3 months for NSQ and SQ NSCLC patients, respectively, while for the PD-(L)1 inhibitor and chemotherapy combination regimen, the median OS was 24.0 months for NSQ and not evaluable for SQ patients.

Interpretation: The majority of advanced NSCLCs in Sweden were tested for PD-L1 expression. Real-world OS in patients with PS 0–1 receiving first-line PD-(L)1 inhibitor-based regimens was similar to what has been reported in pivotal clinical trials on PD-(L)1 inhibitors.

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Author Biography

Anders Vikström, Department of Respiratory Medicine, Linköping University Hospital, Linköping, Sweden

Department of Respiratory Medicine, Linköping University Hospital, Linköping, Sweden

References

World Health Organization. WHO fact sheet cancer 2022 [Internet]. [cited 22-06-2009]. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer

Socialstyrelsen. Cancer i siffror 2018 – Populärvetenskapliga fakta om cancer [Internet]. 2018 [in Swedish] [cited 22-10-2012]. Available from: https://www.socialstyrelsen.se/statistik-och-data/statistik/alla-statistikamnen/cancer/

Ganti AK, Klein AB, Cotarla I, Seal B, Chou E. Update of incidence, prevalence, survival, and initial treatment in patients with non-small cell lung cancer in the US. JAMA Oncol. 2021;7(12):1824–32.

https://doi.org/10.1001/jamaoncol.2021.4932 DOI: https://doi.org/10.1001/jamaoncol.2021.4932

Santarpia M, Giovannetti E, Rolfo C, et al. Recent developments in the use of immunotherapy in non-small cell lung cancer. Expert Rev Respir Med. 2016;10(7):781–98.

https://doi.org/10.1080/17476348.2016.1182866 DOI: https://doi.org/10.1080/17476348.2016.1182866

Borghaei H, Gettinger S, Vokes EE, et al. Five-year outcomes from the randomized, phase III trials CheckMate 017 and 057: nivolumab versus docetaxel in previously treated non-small-cell lung cancer. J Clin Oncol. 2021;39(7):723–33.

https://doi.org/10.1200/jco.20.01605 DOI: https://doi.org/10.1200/JCO.20.01605

Reck M, Rodríguez-Abreu D, Robinson AG, et al. Five-year outcomes with pembrolizumab versus chemotherapy for metastatic non-small-cell lung cancer with PD-L1 tumor proportion score ≥ 50. J Clin Oncol. 2021;39(21):2339–49.

https://doi.org/10.1200/jco.21.00174 DOI: https://doi.org/10.1200/JCO.21.00174

Herbst RS, Garon EB, Kim DW, et al. Five year survival update from KEYNOTE-010: pembrolizumab versus docetaxel for previously treated, programmed death-ligand 1-positive advanced NSCLC. J Thorac Oncol. 2021;16(10):1718–32.

https://doi.org/10.1016/j.jtho.2021.05.001 DOI: https://doi.org/10.1016/j.jtho.2021.05.001

Socinski MA, Nishio M, Jotte RM, et al. IMpower150 final overall survival analyses for atezolizumab plus bevacizumab and chemotherapy in first-line metastatic nonsquamous NSCLC. J Thorac Oncol. 2021;16(11):1909–24.

https://doi.org/10.1016/j.jtho.2021.07.009 DOI: https://doi.org/10.1016/j.jtho.2021.07.009

Paz-Ares L, Luft A, Vicente D, et al. Pembrolizumab plus chemotherapy for squamous non-small-cell lung cancer. N Engl J Med. 2018;379(21):2040–51.

https://doi.org/10.1056/NEJMoa1810865 DOI: https://doi.org/10.1056/NEJMoa1810865

Socinski MA, Jotte RM, Cappuzzo F, et al. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018;378(24):2288–301.

https://doi.org/10.1056/NEJMoa1716948 DOI: https://doi.org/10.1056/NEJMoa1716948

Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med. 2016;375(19):1823–33.

https://doi.org/10.1056/NEJMoa1606774 DOI: https://doi.org/10.1056/NEJMoa1606774

Freeman RK, Van Woerkom JM, Vyverberg A, Ascioti AJ. The effect of a multidisciplinary thoracic malignancy conference on the treatment of patients with lung cancer. Eur J Cardiothorac Surg. 2010;38(1):1–5.

https://doi.org/10.1016/j.ejcts.2010.01.051 DOI: https://doi.org/10.1016/j.ejcts.2010.01.051

Cancercentrum i samverkan. Nationellt vårdprogram för lungcancer 2023 [Cited: 2024-04-04]. Available from: https://kunskapsbanken.cancercentrum.se/diagnoser/lungcancer/vardprogram/.

Evans M, O’Sullivan B, Hughes F, et al. The clinicopathological and molecular associations of PD-L1 expression in non-small cell lung cancer: analysis of a series of 10,005 cases tested with the 22C3 assay. Pathol Oncol Res. 2020;26(1):79–89.

https://doi.org/10.1007/s12253-018-0469-6 DOI: https://doi.org/10.1007/s12253-018-0469-6

Velcheti V, Patwardhan PD, Liu FX, Chen X, Cao X, Burke T. Real-world PD-L1 testing and distribution of PD-L1 tumor expression by immunohistochemistry assay type among patients with ­metastatic non-small cell lung cancer in the United States. PLoS One. 2018;13(11):e0206370.

https://doi.org/10.1371/journal.pone.0206370 DOI: https://doi.org/10.1371/journal.pone.0206370

Dietel M, Savelov N, Salanova R, et al. Real-world prevalence of programmed death ligand 1 expression in locally advanced or metastatic non-small-cell lung cancer: the global, multicenter EXPRESS study. Lung Cancer. 2019;134:174–9.

https://doi.org/10.1016/j.lungcan.2019.06.012 DOI: https://doi.org/10.1016/j.lungcan.2019.06.012

Hwang DM, Albaqer T, Santiago RC, et al. Prevalence and heterogeneity of PD-L1 expression by 22C3 assay in routine population-based and reflexive clinical testing in lung cancer. J Thorac Oncol. 2021;16(9):1490–500.

https://doi.org/10.1016/j.jtho.2021.03.028 DOI: https://doi.org/10.1016/j.jtho.2021.03.028

Tsao MS, Kerr KM, Kockx M, et al. PD-L1 Immunohistochemistry comparability study in real-life clinical samples: results of blueprint phase 2 project. J Thorac Oncol. 2018;13(9):1302–11.

https://doi.org/10.1016/j.jtho.2018.05.013 DOI: https://doi.org/10.1016/j.jtho.2018.05.013

Planchard D, Popat S, Kerr K, et al. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv192–iv237.

https://doi.org/10.1093/annonc/mdy275 DOI: https://doi.org/10.1093/annonc/mdy275

ESMO. Clinical practice living guidelines – Metastatic non-small cell lung cancer: Guidelines for diagnosis, treatment and follow-up 2020 [Cited: 2024-04-04]. Available from: https://www.esmo.org/content/download/347819/6934778/1/ESMO-CPG-MNSCLC-15SEPT2020.pdf.

Garassino MC, Gadgeel S, Speranza G, Felip et al. Pembrolizumab plus pemetrexed and platinum in nonsquamous non-small-cell lung cancer: 5-year outcomes from the phase 3 KEYNOTE-189 study. J Clin Oncol. 2023;41(11):1992–8.

https://doi.org/10.1200/jco.22.01989 DOI: https://doi.org/10.1200/JCO.22.01989

West H, McCleod M, Hussein M, et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2019;20(7):924–37.

https://doi.org/10.1016/s1470-2045(19)30167-6 DOI: https://doi.org/10.1016/S1470-2045(19)30167-6

Cortellini A, Tiseo M, Banna GL, et al. Clinicopathologic correlates of first-line pembrolizumab effectiveness in patients with advanced NSCLC and a PD-L1 expression of ≥ 50. Cancer Immunol Immunother. 2020;69(11):2209–21.

https://doi.org/10.1007/s00262-020-02613-9 DOI: https://doi.org/10.1007/s00262-020-02613-9

Passaro A, Novello S, Giannarelli D, et al. Early progression in non-small cell lung cancer (NSCLC) with high PD-L1 treated with pembrolizumab in first-line setting: a prognostic scoring system based on clinical features. Cancers (Basel). 2021;13(12):2935.

https://doi.org/10.3390/cancers13122935 DOI: https://doi.org/10.3390/cancers13122935

Friedlaender A, Metro G, Signorelli D, et al. Impact of performance status on non-small-cell lung cancer patients with a PD-L1 tumour proportion score ≥50% treated with front-line pembrolizumab. Acta Oncol. 2020;59(9):1058–63.

https://doi.org/10.1080/0284186x.2020.1781249 DOI: https://doi.org/10.1080/0284186X.2020.1781249

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):411–22.

https://doi.org/10.1016/j.cllc.2021.02.001 DOI: https://doi.org/10.1016/j.cllc.2021.02.001

Dudnik E, Moskovitz M, Rottenberg Y, et al. Pembrolizumab as a monotherapy or in combination with platinum-based chemotherapy in advanced non-small cell lung cancer with PD-L1 tumor proportion score (TPS) ≥50%: real-world data. Oncoimmunology. 2021;10(1):1865653.

https://doi.org/10.1080/2162402x.2020.1865653 DOI: https://doi.org/10.1080/2162402X.2020.1865653

Amrane K, Geier M, Corre R, et al. First-line pembrolizumab for non-small cell lung cancer patients with PD-L1 ≥50% in a multicenter real-life cohort: the PEMBREIZH study. Cancer Med. 2020;9(7):2309–16.

https://doi.org/10.1002/cam4.2806 DOI: https://doi.org/10.1002/cam4.2806

Cramer-van der Welle CM, Verschueren MV, et al. Real-world outcomes versus clinical trial results of immunotherapy in stage IV non-small cell lung cancer (NSCLC) in the Netherlands. Sci Rep. 2021;11(1):6306.

https://doi.org/10.1038/s41598-021-85696-3 DOI: https://doi.org/10.1038/s41598-021-85696-3

Velcheti V, Hu X, Yang L, Pietanza MC, Burke T. Long-term real-world outcomes of first-line pembrolizumab monotherapy for metastatic non-small cell lung cancer with ≥50% expression of programmed cell death-ligand 1. Front Oncol. 2022;12:834761.

https://doi.org/10.3389/fonc.2022.834761 DOI: https://doi.org/10.3389/fonc.2022.834761

Waterhouse D, Lam J, Betts KA, et al. Real-world outcomes of immunotherapy-based regimens in first-line advanced non-small cell lung cancer. Lung Cancer. 2021;156:41–9.

https://doi.org/10.1016/j.lungcan.2021.04.007 DOI: https://doi.org/10.1016/j.lungcan.2021.04.007

Khozin S, Miksad RA, Adami J, et al. Real-world progression, treatment, and survival outcomes during rapid adoption of immunotherapy for advanced non-small cell lung cancer. Cancer. 2019;125(22):4019–32.

https://doi.org/10.1002/cncr.32383 DOI: https://doi.org/10.1002/cncr.32383

Liu SV, Hu X, Li Y, Zhao B, Burke T, Velcheti V. Pembrolizumab-combination therapy for previously untreated metastatic nonsquamous NSCLC: real-world outcomes at US oncology practices. Front Oncol. 2022;12:999343.

https://doi.org/10.3389/fonc.2022.999343 DOI: https://doi.org/10.3389/fonc.2022.999343

Additional Files

Published

2024-04-21

How to Cite

Wagenius, G., Vikström, A., Berglund, A., Salomonsson, S., Bencina, G., Hu, X., Chirovsky, D., & Brunnström, H. (2024). First-line Treatment Patterns and Outcomes in Advanced Non-Small Cell Lung Cancer in Sweden: A Population-based Real-world Study with Focus on Immunotherapy. Acta Oncologica, 63(1), 198–205. https://doi.org/10.2340/1651-226X.2024.20309

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