J Cancer 2018; 9(10):1813-1820. doi:10.7150/jca.24985

Research Paper

Tumor PD-L1 Expression and Clinical Outcomes in Advanced-stage Non-Small Cell Lung Cancer Patients Treated with Nivolumab or Pembrolizumab: Real-World Data in Taiwan

Shu-Yung Lin1,2, Ching-Yao Yang3,4✉, Bin-Chi Liao2,5, Chao-Chi Ho4, Wei-Yu Liao4, Kuan-Yu Chen4, Tzu-Hsiu Tsai4, Chia-Lin Hsu4, Wei-Hsun Hsu5, Kang-Yi Su6, Yih-Leong Chang3,7, Jih-Hsiang Lee5, Chia-Chi Lin5, Jin-Yuan Shih4, James Chih-Hsin Yang5, Chong-Jen Yu4

1. Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
2. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
3. Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei City, Taiwan
4. Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
5. Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
6. Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei City, Taiwan
7. Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan

Abstract

Background: Immunotherapy that targets programmed death protein-1 (PD-1) provides improved treatment efficacy and survival in patients with metastatic non-small cell lung cancer (NSCLC), especially those with high tumor expression of PD-L1. However, data on this treatment are mostly from clinical trials enrolling highly selected patients. The real-world experience of anti-PD-1 treatment and the usefulness of tumor PD-L1 expression in prediction of treatment response are largely unknown.

Methods: We retrospectively reviewed patients with stage IIIB/ IV NSCLC who received monotherapy with nivolumab or pembrolizumab, and evaluated response using RECIST 1.1 criteria. Factors associated with treatment response, progression free survival (PFS), and overall survival (OS) were determined.

Results: Seventy-four NSCLC patients out of 116 examined patients were included, most of whom had adenocarcinoma (48/74, 64.9%) and received immunotherapy as a third-line or subsequent treatment (51/74, 68.9%). The median PFS and OS were 1.8 and 7.9 months, respectively. The objective response rate was 32%, but only 47 of 74 patients were evaluable. Through multivariate analysis, epidermal growth factor receptor (EGFR) mutation was independently associated with a poor treatment response. Good performance status (ECOG≤1) and smoking were independently associated with better PFS and OS. Data on tumor PD-L1 expression were available in 43 patients (58%); higher PD-L1 expression correlated with better treatment response and longer PFS. Severe treatment-related adverse events were uncommon.

Conclusion: The efficacy and safety of anti-PD-1 medications for advanced NSCLC were comparable in real-world and clinical settings, except in those with poor ECOG scores. Prediction of treatment response from tumor PD-L1 expression seemed practical.

Keywords: Immunotherapy, Non-small cell lung cancer, Programmed death 1, Real-world, Survival

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
How to cite this article:
Lin SY, Yang CY, Liao BC, Ho CC, Liao WY, Chen KY, Tsai TH, Hsu CL, Hsu WH, Su KY, Chang YL, Lee JH, Lin CC, Shih JY, Yang JCH, Yu CJ. Tumor PD-L1 Expression and Clinical Outcomes in Advanced-stage Non-Small Cell Lung Cancer Patients Treated with Nivolumab or Pembrolizumab: Real-World Data in Taiwan. J Cancer 2018; 9(10):1813-1820. doi:10.7150/jca.24985. Available from http://www.jcancer.org/v09p1813.htm