Real-world second-line outcomes of NSCLC patients receiving first-line chemotherapy plus immunotherapy

Chemotherapy + immunotherapy represents the standard first-line (1L) approach for patients with non-oncogene driven metastatic non-small cell lung cancer (mNSCLC), yet evidence supporting physicians’ choice for second-line (2L) treatment is lacking.

Patient characteristics and treatment patterns of all consecutive NSCLC patients receiving 2L after progression under 1L chemotherapy + immunotherapy were drawn from the ConcertAI Patient360TM dataset, a curated EMR-based US oncology database. 2L real-world progression-free survival (2L-rwPFS) and overall survival (2L-rwOS), as well as objective response rate (2L-ORR) and 2L disease control rate (2L-DCR) were calculated overall and by 2L treatment.

A total of 919 patients were included. The mean age was 66 years, 609 (66%) patients had adenocarcinoma, 398 (43%) were female, and 153 (20%) had a poor ECOG-performance status (≥2) prior to 2L initiation. As 2L, 326 (35%) patients received chemotherapy, 257 (28%) chemotherapy + anti-angiogenic, 247 (16%) immunotherapy alone, 102 (11%) with immunotherapy + chemotherapy, and 81 (14%) targeted therapies. At a median follow up of 28.3 months (mo) post initiation of 2L, median 2L-rwPFS was 4.4 mo (95%CI 3.2-4.7) and median 2L-rwOS was 7.4 mo (95%CI 5.9-7.5). Patients rechallenged with immunotherapy or immunotherapy ± chemotherapy had similar median 2L-rwPFS (p=0.13 and p=0.15, respectively) yet longer median 2L-rwOS (p<0.01 for both) compared to the ones treated with chemotherapy + antiangiogenic. 2L-ORR and 2L-DCR overall and by 2L treatment are detailed in the table.

For mNSCLC patients undergoing 2L treatment after progression to chemo-immunotherapy in the real-world options are limited, and outcomes remain suboptimal. With all the caveats due to unadjusted comparison between treatment groups, our study showed that rechallenging with immunotherapy may be a valid alternative to chemotherapy + anti-angiogenic in selected patients.