Real-life Analysis of Immunotherapy as the Second or Later Lines Treatment in Patients with Metastatic Non-small Cell Lung Cancer

INTRODUCTION: Immunotherapy agents such as atezolizumab and nivolumab are appropriate option for non-small cell lung cancer (NSCLC) accounts in the absence of driver mutation, regardless of PD -L1 expression in second and later line setting. Herein we aimed to evaluate the efficacy and safety of immunotherapy for the second and later line settings in metastatic NSCLC patients as a single center experience.
METHODS: Totally, 37 patients with metastatic NSCLC who received atezolizumab or nivolumab in the second or later lines were included. Clinicopathological features of patients and survival outcomes were analyzed. The safety profile and the factors that may predict survival were also evaluated.
RESULTS: Twenty-nine (78.4%) of patients were men and 8 of patients (21.6%) were woman with median age of 61 years (range: 42-80). Atezolizumab was preferred in 22 (59.5%) of these patients and nivolumab in 15 (40.5%) of them. Objective response rate was %35.1. At a median follow up 22.5 months, median progression-free survival (PFS) was 4.7 months, median overall survival (OS) was 24.1 months. Univariate analysis for PFS revealed that gender (p=0.03), age (p=0.005), the presence of brain metastasis (p=0.02), PDL status >%1 (p=0.035), ECOG PS (p=0.04) and the good response to frontline treatment (p=0.015) were found to be significant prognostic indicators. It also showed that the presence of brain metastasis (p=0.03), PDL status >%1 (p=0.027), good response to frontline treatment (p=0.022) and atezolizumab preference (p=0.018) were prognostic factors for OS.
DISCUSSION AND CONCLUSION: Our real-life analysis indicated that atezolizumab and nivolumab improved survivals with good safety profile in second and later lines treatment of metastatic NSCLC patients.

Metastatik Küçük Hücre Diþi Akciðer Kanseri Hastalarinin Ýkinci veya Ýleri Sýra Tedavisinde Ýmmünoterapinin Gerçek Yaþam Analizi

GÝRÝÞ ve AMAÇ: Atezolizumab ve nivolumab, driver mutasyon yokluðunda, küçük hücre dýþý akciðer kanserinin (KHDAK) ikinci ve sonraki basamak tedavisinde PDL durumundan baðýmsýz olarak kullanýlabilen iyi bir seçenektir. Burada, metastatik KHDAK’li hastalarda ikinci ve sonraki sýra tedavide immünoterapinin etkinliðini ve güvenliðini deðerlendirmeyi tek Merkez deneyimi olarak amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya, ikinci veya sonraki sýralarda atezolizumab veya nivolumab alan toplam 37 metastatik KHDAK hastasý dahil edildi. Hastalarýn klinikopatolojik özellikleri ve saðkalým sonuçlarý analiz edildi. Güvenlik profili ve saðkalýmý öngörebilecek faktörler deðerlendirildi.
BULGULAR: Hastalarýn 29'u (% 78.4) erkek, 8'i (% 21.6) kadýn, ortanca yaþ 61 (aralýk: 42-80) idi. Bu hastalarýn 22'sinde (% 59.5) atezolizumab, 15'inde (% 40.5) nivolumab tercih edilmiþdi. Objektif yanýt oraný % 35.1 idi. Medyan 22.5 aylýk takipte, medyan progresyonsuz saðkalým 4.7 (PSK) ay iken, medyan genel saðkalým (OS) 24.1 ay olarak bulundu. PFS için tek deðiþkenli analizde, cinsiyet (p=0.03), yaþ (p=0.005), beyin metastazý varlýðý (p=0.02), PDL durumu>% 1 (p=0.035), ECOG PS (p=0.04) ve ilk sýra tedaviye iyi yanýt varlýðý (p=0.015) anlamlý prognostik göstergeler olarak bulundu. OS için ise, beyin metastazý varlýðý (p=0.03), PDL durumu>% 1 (p=0.027), ilk sýra tedaviye iyi yanýt varlýðý (p=0.022) ve atezolizumab tercihi (p=0.018) prognostik faktörler olarak bulundu.
TARTIÞMA ve SONUÇ: Gerçek hayat analizimiz, atezolizumab ve nivolumabýn, metastatik KHDAK hastalarýnýn ikinci ve sonraki basamak tedavilerinde iyi güvenlik profili ile saðkalýmý iyileþtirdiðini gösterdi.