First-line Immunotherapy and Clinically Meaningful Survival Benefits for the Oldest Adults With Lung Cancer
Menée aux Etats-Unis à partir de données 2011-2019 portant sur 53 719 patients atteints d'un cancer du poumon non à petites cellules de stade avancé, cette étude de cohorte analyse l'association entre l'évolution de l'utilisation des inhibiteurs de points de contrôle imunitaire et l'évolution de la survie globale et de la probabilité de survie à 2 ans, en fonction de leur catégorie d'âge (âge inférieur ou égal à 55 ans et âge supérieur ou égal à 75 ans)
The adoption of immune checkpoint inhibitors (ICIs) over the past decade has drastically changed the treatment paradigm of non–small cell lung cancer (NSCLC). The novel discovery of inhibiting the programmed cell death (PD) pathway has resulted in improved survival and treatment tolerance compared with chemotherapy. In 2015, the PD-1 inhibitor nivolumab became the first US Food and Drug Administration (FDA)-approved ICI for second-line use in metastatic NSCLC following progression after platinum doublet chemotherapy. In 2016, the PD 1 ligand 1 (PD-L1) inhibitor pembrolizumab was approved for use in the first-line setting for metastatic NSCLC with high PD-L1 expression levels (tumor proportion score ≥50%). Pembrolizumab demonstrated a 15.8-month survival gain over platinum doublet chemotherapy with a median overall survival (OS) of 30 months. In 2017, pembrolizumab in combination with platinum doublet chemotherapy was approved for use in nonsquamous metastatic NSCLC at all PD-L1 expression levels without an activating EGFR or ALK mutation. Median OS for ICI and platinum doublet combination (22 months) was longer than platinum doublet and placebo (10.7 months). Survival with ICI and platinum doublet combination varied across PD-L1 expression levels, with median OS (and survival gain) of 17.2 months (7-month survival gain), 21.8 months (9.7-month survival gain), and not reached for PD-L1 less than 1%, PD-L1 1% to 49%, and PD-L1 greater than 50%, respectively. In 2018, the FDA approved the combination of pembrolizumab and platinum doublet chemotherapy for squamous metastatic NSCLC, and new ICIs continue to emerge for metastatic NSCLC treatment.
JAMA Oncology , commentaire, 2022