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First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study)

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Abstract

Background

Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation.

Methods

This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment.

Results

The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6–15) and 8 (95% CI 6.7–9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2–NA) and 22 (95% CI 17.8–27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2–4 vs. 0–1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS.

Conclusion

In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.

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Availability of data and material

Datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Oncology Department, Brest University Hospital, Brest, France

    Renaud Descourt

  2. Multidisciplinary Oncology and Therapeutic Innovations Department, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Aix Marseille University, Marseille, France

    Laurent Greillier

  3. Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France

    Maurice Perol

  4. Pneumology Department, Rennes University Hospital, Rennes, France

    Charles Ricordel

  5. Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France

    Jean-Bernard Auliac & Christos Chouaïd

  6. Pneumology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône Hospital, Gleize, France

    Lionel Falchero

  7. Oncology Department, Caen François-Baclesse Cancer Center, Caen, France

    Radj Gervais

  8. Pneumology Department, Bordeaux University Hospital, Bordeaux, France

    Rémi Veillon

  9. Oncology Department, Perpignan Hospital, Perpignan, France

    Sabine Vieillot

  10. Pneumology Department, Rouen University Hospital, Rouen, France

    Florian Guisier

  11. Pneumology Department, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France

    Marie Marcq

  12. Oncology Department, Angers University Hospital, Angers, France

    Grégoire Justeau

  13. Pneumology Department, Toulouse University Hospital, Toulouse, France

    Laurence Bigay-Game

  14. Pneumology Department, Aix-en-Provence Hospital, Aix-en-Provence, France

    Marie Bernardi

  15. Oncology Department, Institut de Cancérologie de La Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France

    Pierre Fournel

  16. Pneumology Department, Hôpital Foch, Suresnes, France

    Hélène Doubre

  17. Pneumology Department, Chambéry Métropole Savoie Hospital, Chambéry, France

    Julian Pinsolle

  18. Oncology Department, Morlaix Hospital, Morlaix, France

    Karim Amrane

  19. Pneumology Department, Annecy Genevois Hospital, Annecy, France

    Chantal Decroisette

Authors
  1. Renaud Descourt
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  2. Laurent Greillier
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  3. Maurice Perol
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  4. Charles Ricordel
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  5. Jean-Bernard Auliac
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  6. Lionel Falchero
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  7. Radj Gervais
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  8. Rémi Veillon
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  9. Sabine Vieillot
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  10. Florian Guisier
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  11. Marie Marcq
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  12. Grégoire Justeau
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  13. Laurence Bigay-Game
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  14. Marie Bernardi
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  15. Pierre Fournel
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  16. Hélène Doubre
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  17. Julian Pinsolle
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  18. Karim Amrane
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  19. Christos Chouaïd
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  20. Chantal Decroisette
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RD, LG, CC and CD. The first draft of the manuscript was written by RD, CC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Christos Chouaïd.

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Conflict of interest

L. Greillier reports grants, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, Bayer and Amgen, outside the submitted work. C. Chouaid reports grants, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, GSK, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, Bayer and Amgen, outside the submitted work. C. Decroisette reports personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, and Amgen, outside the submitted work. M. Pérol reports personal fees and non-financial support from Roche, Eli Lilly, Pfizer, Boehringer Ingelheim, Merck Sharp & Dohme, Bristol-Myers Squibb, Novartis, AstraZeneca, Takeda, Gritstone, Sanofi, GlaxoSmithKline, Amgen, Chugai, Illumina, Daïchi-Sankyo and Abbvie outside the submitted work. R. Descourt reports personal fees and non-financial support from AstraZeneca, Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Takeda, and Chugai, outside the submitted work. C. Ricordel, J.B. Auliac, L. Falchero, R. Gervais, R. Veillon, S. Vieillot, F. Guisier, M. Marcq, G. Justeau, L. Bigay-Game, M. Bernardi, P. Fournel, H. Doubre, J. Pinsolle and K. Amrane report no conflict of interest.

Ethical approval

The study conformed to the principles of the Declaration of Helsinki and Good Clinical Practice Guidelines. It was approved by a national independent Ethics Committee (2019-A02073-54, on December, 11, 2019).

Consent to participate

Patients received written and oral information on the study and gave their consent to participate in the study and for the use of their medical data for research purposes.

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Descourt, R., Greillier, L., Perol, M. et al. First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study). Cancer Immunol Immunother 72, 91–99 (2023). https://doi.org/10.1007/s00262-022-03232-2

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