First-line pembrolizumab plus platinum-pemetrexed in metastatic non-small cell lung cancer: Clinical experience in a Spanish tertiary hospital.

person Lara Lombardero Department of Medical Oncology. Hospital universitario de Cruces, Barakaldo, Spain info_outline Lara Lombardero, Ibone De Elejoste, Raquel Casas, Josune Azcuna, Berezi Ortega, Failah Mohamed Lamin, Pablo Jiménez Labaig, Itziar Rubio, Alberto Munoz Llarena, Eider Azkona

Authors person Lara Lombardero Department of Medical Oncology. Hospital universitario de Cruces, Barakaldo, Spain info_outline Lara Lombardero, Ibone De Elejoste, Raquel Casas, Josune Azcuna, Berezi Ortega, Failah Mohamed Lamin, Pablo Jiménez Labaig, Itziar Rubio, Alberto Munoz Llarena, Eider Azkona Organizations Department of Medical Oncology. Hospital universitario de Cruces, Barakaldo, Spain, Hospital Universitario Donostia, Donostia, Spain, Department of Medical Oncology, Hospital Universitario Cruces, Barakaldo, Spain, Department of Medical Oncology., Hospital Universitario Cruces, Barakaldo, Spain, Department of Medical Oncology, Hospital universitario Cruces, Barakaldo, Spain, Department of Medical Oncology. Cruces University Hospital, Barakaldo, Spain, Hospital de Cruces, Bizkaia, Spain, Department of Medical Oncology. Hospital Universitario Cruces, Barakaldo, Spain Abstract Disclosures Research Funding No funding received None. Background: In the phase III trial KEYNOTE-189 first-line pembrolizumab (pembro) plus platinum-pemetrexed (pem) significantly improved OS and PFS in metastatic nonsquamous non-small cell lung cancer (NSCLC) without EGFR/ALK alterations. We report outcomes of real-world patients (pts) treated with first line pembro plus platinum-pem in our hospital. Methods: We have done a descriptive, retrospective, single center study developed in a Spanish tertiary hospital where patients with metastatic nonsquamous NSCLC treated with first-line pembro plus platinum-pem have been included. SPSS v23 software has been used to analyze clinical data for OS and PFS using the Kaplan-Meier method. PFS-2, defined as time from first treatment to objective tumor progression on next-line treatment or death from any cause, whichever occurred first, was also recorded using the Kaplan-Meier method. Adverse events (AEs) were graded according to CTCAE v5.0. Results: From December 2019 to May 2022, 79 pts (67.1% M, 26% W; 64y median age, ECOG 0, 1, 2: 5.1%; 88.6% and 6.3%; PD-L1 < 1% 36 [45.6%], PD-L1 1-49% 37 [36.8%], PD-L1 50% 3 [3.8%]; unknown PD-L1 3 [3.8%]; 95% adenocarcinoma) were assessed. After a median follow-up of 19 months, OS was 17 months (5.3-28.7). Stratified by PD-L1 expression, mOS was 9 months (6.3 -11.7) in PD-L1 < 1%; 25 months in PD-L1 1-49%, NR in the rest. Median PFS was 9 months (5.8-12.2). According to PD-L1 expression, mPFS was 6 months (4.6 - 7.4) in PD-L1 < 1%; 19 months (8.7 - 29.2) PD-L1 1-49% and 7 months (0.6 - 13.4) in PD-L1 50%. PFS-2 was 17 months (10.7 - 23.3). At the time of the cut off 66 pts (83.5%) had discontinued treatment: 35 (53%) due to progression, 23 (34.8%) due to toxicity; 2 (3%) due to both, and 6 (9.1%) due to other reasons. Grade 3-5 AEs were observed in 35/79 pts (44.3%). 15.2% pts needed dose-reduction and 32.6% glucocorticoids. Conclusions: First-line treatment with pembro plus platinum-pem has demonstrated benefit in terms of OS, PFS and PFS-2 with tolerable adverse effects. The results obtained in our hospital, taken together, are consistent with those published in KEYNOTE-189 trial. However, the survival of our pts with PD-L1 < 1% seems to be poorer. This finding could be explained by the short median follow-up, low number of patients and differences in baseline demographic characteristics.