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Upfront pembrolizumab as an effective treatment start in patients with PD-L1 ≥ 50% non-oncogene addicted non-small cell lung cancer and asymptomatic brain metastases: an exploratory analysis

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Abstract

Introduction

The efficacy of immune checkpoint inhibitors in patients with brain metastases (BMs) from non-oncogene addicted non-small cell lung cancer (NSCLC) is under investigation. Here, we sought to determine the optimal management of NSCLCs with PD-L1 ≥ 50% and asymptomatic BMs who were treated with first-line pembrolizumab.

Methods

Thirty patients from 15 institutions with PD-L1 ≥ 50% NSCLC had asymptomatic BMs, and met inclusion criteria. Patients were classified based on whether they had undergone upfront local radiotherapy for BMs as well as on the type of brain radiotherapy received.

Results

Nine patients were treated with upfront pembrolizumab alone, 8 patients with whole-brain radiotherapy (WBRT) followed by pembrolizumab and 13 patients with stereotactic radiosurgery (SRS) followed by pembrolizumab. Patients’ characteristics were similar among the three groups of patients except for a higher number of BMs ≥ 3 in the WBRT group. One complete and 4 partial intracranial responses were observed with upfront pembrolizumab alone. The median survival was not reached for the pembrolizumab and WBRT (n = 8) groups, and it was 7.6 months for the SRS (n = 13) group (P = 0.09), with 12-month survival rates being 55.5%, 62.5%, and 23.0%, respectively. Salvage WBRT was delivered in 1 patient in the upfront pembrolizumab group and in 4 patients in the SRS group.

Conclusions

Upfront pembrolizumab showed efficacy in selected patients with PD-L1 ≥ 50% non-oncogene addicted NSCLC and asymptomatic BMs. Prospective studies should address whether pembrolizumab alone, and deferral of radiotherapy, could be pursued in this patient population.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Via Dottori, 1, 06156, Perugia, Italy

    G. Metro & M. Garaffa

  2. Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy

    A. Gili

  3. Medical Oncology Department, National Cancer Institute of Milano, Milan, Italy

    D. Signorelli & A. De Toma

  4. Thoracic Oncology Unit, IRCCS “Giovanni Paolo II” Cancer Institute, Bari, Italy

    D. Galetta

  5. Oncology Department, Attikon University Hospital, Athens, Greece

    P.. Economopoulou

  6. Department of Oncology, Geneva University Hospital, Geneva, Switzerland

    A. Friedlaender & A.. Addeo

  7. Medical Oncology, ‘HM Sanchinarro’ University Hospital, Madrid, Spain

    B. Jimenez & A. Collazo-Lorduy

  8. Division of Neuroradiology, Santa Maria della Misericordia Hospital, Perugia, Italy

    P. Chiarini

  9. Department of Medicine, Neurology Clinic, University Hospital of Perugia, Perugia, Italy

    C. Costa

  10. Second Department of Medical Oncology, Henry Dunant Hospital Center, Athens, Greece

    G. Mountzios

  11. Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy

    F. Roila

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  1. G. Metro
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  2. A. Gili
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  3. D. Signorelli
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  4. A. De Toma
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  5. M. Garaffa
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  6. D. Galetta
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  8. A. Friedlaender
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  9. B. Jimenez
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  10. A. Collazo-Lorduy
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  11. A.. Addeo
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  12. P. Chiarini
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  13. C. Costa
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  14. G. Mountzios
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  15. F. Roila
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Contributions

Study conception and design: GM. Acquisition of data: all authors. Analysis and interpretation of data: GM and AG. Drafting of manuscript: GM. Critical revision and final approval of the manuscript: all authors.

Corresponding author

Correspondence to G. Metro.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individuals included in the study, whenever possible, taking into account the retrospective nature of the study.

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Metro, G., Gili, A., Signorelli, D. et al. Upfront pembrolizumab as an effective treatment start in patients with PD-L1 ≥ 50% non-oncogene addicted non-small cell lung cancer and asymptomatic brain metastases: an exploratory analysis. Clin Transl Oncol 23, 1818–1826 (2021). https://doi.org/10.1007/s12094-021-02588-8

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  • DOI: https://doi.org/10.1007/s12094-021-02588-8

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