Real-world treatment and retreatment patterns and outcomes in patients with advanced or metastatic non-small cell lung cancer following nivolumab monotherapy in second line or later in France: an I-O Optimise analysis

Gregoire Justeau ^1* Christos Chouaid ² Didier Debieuvre ³ Clarisse Audigier-Valette ⁴ Xavier Quantin ⁵ Herve Lena ⁶ Lise Bosquet ⁷ Nicolas Girard ⁸ Minouk J Schoemaker ⁹ Marta Mella ¹⁰ Bárbara Pinto Correia ¹¹ Caroline Rault ¹² Melinda J Daumont ¹³ John R Penrod ¹⁴ Adam Lee ¹⁴ Maurice Pérol ¹⁵

• ¹ Centre Hospitalier Universitaire d'Angers, Angers, France
• ² Hospital Center Intercommunal De Créteil, Créteil, France
• ³ Groupe Hospitalier de la Région de Mulhouse et Sud Alsace (GHRMSA), Mulhouse, Alsace, France
• ⁴ Hôpital Sainte Musse, Toulon, France
• ⁵ Département d'oncologie médicale, Institut du Cancer de Montpellier (ICM), Montpellier, Languedoc-Roussillon, France
• ⁶ University Hospital, Rennes, France
• ⁷ Health Data and Partnerships Department, Unicancer, Paris, France
• ⁸ Institut Curie, Paris, Ile-de-France, France
• ⁹ IQVIA (Netherlands), Amsterdam, Netherlands
• ¹⁰ IQVIA, Milan, Italy
• ¹¹ IQVIA (Portugal), Porto Salvo, Portugal
• ¹² Data-Gnosis, Rennes, France
• ¹³ Bristol Myers Squibb, Brussels, Belgium
• ¹⁴ Bristol Myers Squibb (United States), New York, New York, United States
• ¹⁵ Centre Léon Bérard, Lyon, Rhône-Alpes, France

Introduction: This study describes treatment and retreatment patterns and outcomes in patients in France following nivolumab as a second-line or later (2L+) treatment in locally advanced and metastatic non-small cell lung cancer (LAM NSCLC).Materials and Methods: This analysis included adults with tumor, node, metastasis stage IIIB–IV NSCLC (as defined in 7th or 8th edition American Joint Committee on Cancer/Union for International Cancer Control) treated with nivolumab monotherapy in 2L+, using data from the retrospective Epidemiological-Strategy and Medical Economics Lung Cancer database. The inclusion period was from January 1, 2015 to September 30, 2020, with follow-up to September 30, 2021. Analyses were stratified according to duration of index nivolumab treatment and tumor programmed death-ligand 1 expression levels.Results: In total, the study included 4,001 patients (68% male; mean age [standard deviation] at index date: 63.6 [9.7] years) with median follow-up of 34.3 months. Median nivolumab duration was 2.5 months (interquartile range: 1.4–6.3). Median overall survival (OS) from nivolumab initiation was 10.2 months (95% confidence interval [CI]: 9.6–10.8). Median real-world progression-free survival and time to treatment discontinuation or death (95% CI) were 2.2 (2.1–2.3) and 2.7 (2.5–2.8) months, respectively. In total, 2,985 (74.6%) patients discontinued index nivolumab treatment: 226 (7.6% of discontinuers) received a further immune checkpoint inhibitor (ICI; 12.3% of discontinuers receiving further systemic treatment); 1,604 (53.7%) received chemotherapy and/or targeted therapy. The proportion of ICI-retreated patients was highest among those with the longest index treatment duration (15.8% among discontinuers receiving ≥26 weeks’ index nivolumab). Median OS from retreatment was longer in the resumption (ICI restart without another therapy for ≥6 weeks) compared with the rechallenge (ICI restart following non-ICI therapy) patient subgroup.Conclusion: Few patients with LAM NSCLC in France received ICI retreatment following index nivolumab discontinuation, but the proportion increased with longer duration of index nivolumab.