Methods
Patient characteristics, treatment patterns, and outcomes were analyzed for all consecutive mNSCLC patients progressing on 1L chemo-immunotherapy. Patients were excluded if they had EGFR/ALK alterations or received target therapies as subsequent treatment. Data were sourced from the US-based ConcertAI Patient360™ dataset.
Results
Among a total of 1030 patients, median age was 66 years, 830 (80%) had non-squamous mNSCLC, 460 (45%) were female, and 153 (20%) had ECOG PS ≥2. Following progression on 1L chemoimmunotherapy, 381 (37%) patients received chemotherapy, 323 (31%) chemotherapy + anti-angiogenic agents, 187 (18%) continued immunotherapy alone, and 139 (14%) continued immunotherapy while switching the chemotherapy agent. At a median follow-up of 15.6 months (mo) after progression to 1L, overall median progression-free survival (mPFS) was 3.8 mo (95%CI 3.4–4.3) and median overall survival (mOS) was 7.9 mo (95%CI 7.0–8.8). Chemotherapy alone yielded a mPFS of 3.6 mo (95% CI: 3.2–4.4), a mOS of 7.2 mo (95% CI: 6.5–8.0), an objective response rate (ORR) of 19%, and a disease control rate (DCR) of 34%. Chemotherapy + anti-angiogenic agents led to a mPFS of 4.0 mo (95% CI: 3.5–4.9) and a mOS of 6.6 mo (95% CI: 5.9–8.4); ORR and DCR were 30% and 44%, respectively. Patients continuing immunotherapy alone achieved a mPFS of 3.6 mo (95% CI: 3.1–5.7), a mOS of 12.7 mo (95% CI: 9.9–17.7), an ORR of 26%, and a DCR of 41%. Chemo-immunotherapy resulted in a mPFS of 4.2 months (95% CI: 2.8–5.9) and a mOS of 10.3 months (95% CI: 7.9–16.0), with ORR and DCR at 24% and 42%, respectively.
Conclusions
In real-world practice, treatment options for mNSCLC patients progressing on 1L chemo-immunotherapy are limited and yield suboptimal outcomes. Despite only descriptive, our study shows that immunotherapy beyond progression may represent an alternative to chemotherapy ± anti-angiogenic agents in patients with slow progression or low disease burden.
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