Upfront pembrolizumab as an effective treatment start in patients with PD-L1 ≥ 50% non-oncogene addicted non-small cell lung cancer and asymptomatic brain metastases: an exploratory analysis.
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ adverse effects
Antineoplastic Agents, Immunological
/ adverse effects
Asymptomatic Diseases
B7-H1 Antigen
/ metabolism
Brain Neoplasms
/ drug therapy
Carcinoma, Non-Small-Cell Lung
/ drug therapy
Cranial Irradiation
/ methods
Female
Humans
Lung Neoplasms
/ metabolism
Male
Middle Aged
Radiosurgery
/ statistics & numerical data
Retrospective Studies
Salvage Therapy
/ methods
Treatment Outcome
Brain metastases
Brain radiotherapy
Immune checkpoint inhibitor
Non-small cell lung cancer
PD-L1 ≥ 50%
Pembrolizumab
Journal
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
ISSN: 1699-3055
Titre abrégé: Clin Transl Oncol
Pays: Italy
ID NLM: 101247119
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
21
12
2020
accepted:
08
03
2021
pubmed:
18
3
2021
medline:
15
12
2021
entrez:
17
3
2021
Statut:
ppublish
Résumé
The efficacy of immune checkpoint inhibitors in patients with brain metastases (BMs) from non-oncogene addicted non-small cell lung cancer (NSCLC) is under investigation. Here, we sought to determine the optimal management of NSCLCs with PD-L1 ≥ 50% and asymptomatic BMs who were treated with first-line pembrolizumab. Thirty patients from 15 institutions with PD-L1 ≥ 50% NSCLC had asymptomatic BMs, and met inclusion criteria. Patients were classified based on whether they had undergone upfront local radiotherapy for BMs as well as on the type of brain radiotherapy received. Nine patients were treated with upfront pembrolizumab alone, 8 patients with whole-brain radiotherapy (WBRT) followed by pembrolizumab and 13 patients with stereotactic radiosurgery (SRS) followed by pembrolizumab. Patients' characteristics were similar among the three groups of patients except for a higher number of BMs ≥ 3 in the WBRT group. One complete and 4 partial intracranial responses were observed with upfront pembrolizumab alone. The median survival was not reached for the pembrolizumab and WBRT (n = 8) groups, and it was 7.6 months for the SRS (n = 13) group (P = 0.09), with 12-month survival rates being 55.5%, 62.5%, and 23.0%, respectively. Salvage WBRT was delivered in 1 patient in the upfront pembrolizumab group and in 4 patients in the SRS group. Upfront pembrolizumab showed efficacy in selected patients with PD-L1 ≥ 50% non-oncogene addicted NSCLC and asymptomatic BMs. Prospective studies should address whether pembrolizumab alone, and deferral of radiotherapy, could be pursued in this patient population.
Identifiants
pubmed: 33728869
doi: 10.1007/s12094-021-02588-8
pii: 10.1007/s12094-021-02588-8
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Antineoplastic Agents, Immunological
0
B7-H1 Antigen
0
CD274 protein, human
0
pembrolizumab
DPT0O3T46P
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1818-1826Informations de copyright
© 2021. Federación de Sociedades Españolas de Oncología (FESEO).
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