Second-line treatment outcomes after progression from first-line chemotherapy plus immunotherapy in patients with advanced non-small cell lung cancer. (April 2023)

• Record Type: Journal Article
• Authors: Auclin, Edouard; Benitez-Montanez, Jose; Tagliamento, Marco; Parisi, Francesca; Gorria, Teresa; Garcia-Campelo, Rosario; Dempsey, Naomi; Pinato, David J.; Reyes, Roxana; Albarrán-Artahona, Víctor; Dall'Olio, Filippo; Soldato, Davide; Hendriks, Lizza; Nana, Frank Aboubakar; Tonneau, Marion; Lopez-Castro, Rafael; Nadal, Ernest; Kazandjian, Suzanne; Muanza, Thierry; Blanc-Durand, Félix; Fabre, Elizabeth; Castro, Natalia; Arasanz, Hugo; Rochand, Adrien; Besse, Benjamin; Routy, Bertrand; Mezquita, Laura
• Is Part Of: Lung cancer. Volume 178(2023)
• Page Start: 116
• Page End: 122
• Publication Date: 2023-04
• Subjects: Non small cell lung cancer -- Chemo-immunotherapy -- Second line -- Prognosis -- Survival; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2023.02.002
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: No standard of care exists for L2 treatment after L1 chemo-immunotherapy in NSCLC. Platinum rechallenge and taxane + antiangiogenic are valuable regimens in this setting. Patients resistant to L1 treatment (PFS < 6mo) have poorer outcomes in L2. Patients with high PD-L1 expressing tumors had better outcomes in L2. Abstract: Introduction: Chemotherapy plus immunotherapy is the standard of care for patients with metastatic NSCLC. No study has evaluated the outcomes of second-line chemotherapy treatments after progression following first-line chemo-immunotherapy. Method: This multicenter retrospective study evaluated the efficacy of second line (2L) chemotherapies after progression under first-line (1L) chemo-immunotherapy, measured by overall survival (2L-OS) and progression free survival (2L-PFS). Results: A total of 124 patients were included. The mean age was 63.1 years, 30.6 % of the patients were female, 72.6 % had an adenocarcinoma and 43.5 % had a poor ECOG-performance status prior to 2L initiation. Sixty-four (52.0 %) patients were considered resistant to first line chemo-immunotherapy. (1L-PFS < 6 months). In 2L treatments, 57 (46.0 %) patients received taxane monotherapy, 25 (20.1 %) taxane plus anti-angiogenic, 12 (9.7 %) platinum-based chemotherapy and 30 (24.2 %) other chemotherapy. At a median follow-up of 8.3 months (95 %CI: 7.2–10.2), post initiation of 2L treatment, the median 2L-OS was 8.1 months (95 % CI: 6.4–12.7) and the median 2L-PFS was 2.9 months (95 %CI: 2.4–3.3). Overall, the 2L-objective response and 2L-disease control rates were 16.0 %, and 42.5 %, respectively. Taxane plus anti-angiogenic and platinum rechallenge achieved longest median 2L-OS: not reached (95 %CI: 5.8-NR) and 17.6 months (95 %CI 11.6-NR), respectively (p = 0.05). Patients resistant to the 1L treatment had inferior outcomes (2L-OS 5.1 months, 2L-PFS 2.3 months) compared with 1L responders (2L-OS 12.7 months, 2L-PFS 3.2 months). Conclusion: In this real-life cohort, 2L chemotherapy achieved modest activity following progression under chemo-immunotherapy. 1L-resistant patients remained a refractory population, highlighting a need for new 2L strategies.