Low-dose pembrolizumab in the treatment of advanced non-small cell lung cancer.
Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ therapeutic use
Antineoplastic Agents, Immunological
/ therapeutic use
Carcinoma, Non-Small-Cell Lung
/ drug therapy
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Humans
Lung Neoplasms
/ drug therapy
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Rate
Asia
low dose
non-small cell lung cancer
pembrolizumab
Journal
International journal of cancer
ISSN: 1097-0215
Titre abrégé: Int J Cancer
Pays: United States
ID NLM: 0042124
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
revised:
01
01
2021
received:
07
10
2020
accepted:
10
02
2021
pubmed:
27
2
2021
medline:
7
9
2021
entrez:
26
2
2021
Statut:
ppublish
Résumé
A dose of 200 mg 3-weekly of pembrolizumab was approved by the Food and Drug Administration (FDA) as treatment for advanced non-small cell lung cancer (NSCLC) without oncogenic drivers. This is despite evidence showing no difference in efficacy with 2 mg/kg. Our study aimed to assess the efficacy of a lower fixed dose of 100 mg, which is closer to 2 mg/kg weight-based dose in an average-sized Asian patient. All patients receiving pembrolizumab for advanced NSCLC from January 2016 to March 2020 in National University Hospital, Singapore, were included in this retrospective observational study. The effect of pembrolizumab 100 mg (Pem100) vs 200 mg (Pem200) upon survival outcomes, toxicity and cost were examined. One hundred fourteen patients received pembrolizumab. Sixty-five (57%) and 49 (43%) received Pem100 and Pem200, respectively. There was no difference in progression-free survival (PFS) and overall survival (OS) between Pem100 vs Pem200 as a single agent (PFS: 6.8 vs 4.2 months, hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.36-1.46, P = .36; 9 month OS: 58% vs 63%, HR 1.08, 95% CI 0.48-2.41, P = .86) and when combined with chemotherapy (9-month PFS: 60% vs 50%, HR0.84, 95% CI 0.34-2.08, P = .71; 9-month OS: 85% vs 58%, HR 0.27, 95% CI 0.062-1.20, P = .09). No significant difference in response rate or ≥G3 immune-related toxicities between Pem100 and Pem200 was observed. A cost minimisation analysis evaluating the degree of cost savings related to drug costs estimated a within study cost saving of SGD4,290,912 and cost saving per patient of SGD39,942 in the Pem100 group. A 100 mg of pembrolizumab appears to be effective with reduction in cost. A randomised trial should be done to investigate a lower dose of pembrolizumab.
Identifiants
pubmed: 33634869
doi: 10.1002/ijc.33534
pmc: PMC9545741
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Antineoplastic Agents, Immunological
0
pembrolizumab
DPT0O3T46P
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
169-176Informations de copyright
© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of Union for International Cancer Control.
Références
Appl Immunohistochem Mol Morphol. 2016 Jul;24(6):392-7
pubmed: 27333219
Clin Liver Dis. 2010 Feb;14(1):137-51; x
pubmed: 20123446
Lancet. 2016 Apr 9;387(10027):1540-1550
pubmed: 26712084
Expert Rev Anticancer Ther. 2016;16(1):13-20
pubmed: 26588948
Eur J Cancer. 2016 Jul;62:132-7
pubmed: 27189322
Oncologist. 2017 Nov;22(11):1392-1399
pubmed: 28835513
N Engl J Med. 2018 May 31;378(22):2078-2092
pubmed: 29658856
J Thorac Oncol. 2020 Jul;15(7):1119-1136
pubmed: 32422364
Lancet. 2019 May 4;393(10183):1819-1830
pubmed: 30955977
CPT Pharmacometrics Syst Pharmacol. 2017 Jan;6(1):21-28
pubmed: 27863143
J Natl Cancer Inst. 2017 Nov 1;109(11):
pubmed: 29059432
Ecancermedicalscience. 2020 Apr 01;14:ed97
pubmed: 32269597
Int J Cancer. 2021 Jul 1;149(1):169-176
pubmed: 33634869
Annu Rev Immunol. 2008;26:677-704
pubmed: 18173375
Proc Natl Acad Sci U S A. 2002 Sep 17;99(19):12293-7
pubmed: 12218188
N Engl J Med. 2018 Nov 22;379(21):2040-2051
pubmed: 30280635
CPT Pharmacometrics Syst Pharmacol. 2017 Jan;6(1):29-39
pubmed: 27896938
Ann Oncol. 2017 Jun 1;28(6):1388-1398
pubmed: 30052728
Ann Oncol. 2017 Apr 1;28(4):874-881
pubmed: 28168303
BMC Public Health. 2012 Jun 18;12:439
pubmed: 22709383
N Engl J Med. 2016 Nov 10;375(19):1823-1833
pubmed: 27718847
Clin Pharmacol Ther. 2018 Apr;103(4):582-590
pubmed: 28913853
Semin Oncol. 2016 Aug;43(4):514-25
pubmed: 27663483
Nat Rev Immunol. 2002 Feb;2(2):116-26
pubmed: 11910893
J Glob Oncol. 2019 Jul;5:1-5
pubmed: 31348737
N Engl J Med. 2015 May 21;372(21):2018-28
pubmed: 25891174
J Clin Oncol. 2019 Mar 1;37(7):537-546
pubmed: 30620668
J Immunother Cancer. 2017 May 16;5:43
pubmed: 28515943
J Clin Oncol. 2020 May 10;38(14):1505-1517
pubmed: 32150489
J Natl Cancer Inst. 2017 Nov 1;109(11):
pubmed: 29059436
Lancet Oncol. 2016 Nov;17(11):1497-1508
pubmed: 27745820
Ther Adv Med Oncol. 2019 Aug 28;11:1758835919870360
pubmed: 31497071
PLoS One. 2017 Aug 10;12(8):e0183023
pubmed: 28797130
ESMO Open. 2018 Jul 25;3(5):e000332
pubmed: 30094065
J Pharmacokinet Pharmacodyn. 2017 Oct;44(5):403-414
pubmed: 28573468
J Clin Oncol. 2019 Oct 1;37(28):2518-2527
pubmed: 31154919
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593