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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Thoracic Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1510278
This article is part of the Research Topic Immune Predictive and Prognostic Biomarkers in Immuno-Oncology: Refining the Immunological Landscape of Cancer View all articles

First-line pembrolizumab in patients with advanced non-small cell lung cancer and high PD-L1 expression: real-world data from a Spanish multicenter study

Provisionally accepted
Aida Piedra Aida Piedra 1,2Sergio Martínez-Recio Sergio Martínez-Recio 1Ainhoa Hernández Ainhoa Hernández 3Teresa Moran Teresa Moran 3Edurne Arriola Edurne Arriola 4Jordi Recuero-Borau Jordi Recuero-Borau 5Manuel Cobo Dols Manuel Cobo Dols 6Patricia Cordeiro Patricia Cordeiro 7Joaquín Mosquera Joaquín Mosquera 7Manuel Fernández Manuel Fernández 7Rosario García-Campelo Rosario García-Campelo 7Antonio Calles Antonio Calles 8Rosa Maria Alvarez Rosa Maria Alvarez 8María Zapata-García María Zapata-García 9DOLORES ISLA DOLORES ISLA 9Ana Callejo Perez Ana Callejo Perez 10Patricia Iranzo Patricia Iranzo 10Jorgina Serra-López Jorgina Serra-López 1Andrés Barba Joaquín Andrés Barba Joaquín 11Ivana Sullivan Ivana Sullivan 1Enriqueta Felip Enriqueta Felip 10MARGARITA MAJEM MARGARITA MAJEM 1*
  • 1 Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  • 2 Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain, Barcelona, Spain
  • 3 Medical Oncology Department, ICO Badalona, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
  • 4 Medical Oncology Department, Hospital del Mar – CIBERONC, Barcelona, Spain
  • 5 Medical Oncology Department, Hospital del Mar, Barcelona, Spain
  • 6 Medical Oncology Department, Hospital Regional Universitario Virgen de la Victoria (IBIMA), Málaga, Spain
  • 7 Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
  • 8 Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
  • 9 Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
  • 10 Medical Oncology Department, Hospital Universitario Vall d´Hebron – VHIO, Barcelona, Spain
  • 11 Medical Oncology Department. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, Barcelona, Balearic Islands, Spain

The final, formatted version of the article will be published soon.

    Pembrolizumab stands as a first-line option for patients with advanced non-small cell lung cancer (NSCLC) and high programmed death-ligand 1 (PD-L1) expression (PD-L1 ≥50%). Several factors such as antibiotic exposure, low body mass index (BMI), specific metastatic location or poor performance status may influence outcomes. We conducted a multicenter retrospective analysis in a cohort of patients with advanced high PD-L1 expression NSCLC treated with first-line pembrolizumab in clinical practice. We sought to evaluate clinical outcomes according to several factors. Among the 494 patients included, median age was 67.29 years, 77% were male, 54% and 38% were former or current smokers, respectively; 84% had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0-1, and 48% had a BMI of <25. 32% of patients had bone metastases, 32% had brain metastases and 16% had liver metastases. 35% of patients were exposed to antibiotics (AB), 44% to corticosteroids and 62% to proton pump inhibitors (PPi). With a median follow-up of 14.2 months, the median overall survival (OS) and progression-free survival (PFS) were 15.9m (95% CI 13.1 to 18.8) and 9.9m (95% CI 7.7 to 12.1), respectively, and the overall response rate (ORR) was 43%. After univariate analysis, median OS in patients with ECOG-PS 0 vs. 1 vs. 2 was 36.7m vs. 14.8m vs. 2.7m (p<0.001). Median OS in patients treated with corticosteroids vs. those without exposure was 11.4m vs. 22.3m (p<0.001). After multivariate analysis, corticosteroid exposure (HR 1.41) and ECOG-PS (HR 2.40) maintained a prognostic impact.

    Keywords: Pembrolizumab 1, Non-Small Cell Lung Cancer 2, first-line 3, predictive factors 4, high PD-L1 expression 5, immune check-point inhibitors6

    Received: 12 Oct 2024; Accepted: 29 Nov 2024.

    Copyright: © 2024 Piedra, Martínez-Recio, Hernández, Moran, Arriola, Recuero-Borau, Dols, Cordeiro, Mosquera, Fernández, García-Campelo, Calles, Alvarez, Zapata-García, ISLA, Callejo Perez, Iranzo, Serra-López, Barba Joaquín, Sullivan, Felip and MAJEM. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: MARGARITA MAJEM, Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.