Platinum-based chemotherapy is still the standard of care for Epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) patients after developing EGFR-TKI resistance. However, no study focusing on the role of PD-1 inhibitor based treatments for EGFR mutated NSCLC patients who carried PD-L1 TPS ≥ 50% progressed after EGFR-TKI therapy. Thus, we aimed to investigate the outcomes of PD-1 inhibitor based treatments for these patients and to explore the population that may benefited from PD-1 inhibitor based therapies.
We retrospectively collected data of EGFR mutated advanced NSCLC patients with PD-L1 TPS≥50% who have failed prior EGFR-TKI therapies without T790M mutation at Shanghai Chest Hospital between January 2018 and June 2021. Progression-free survival (PFS) and overall survival (OS) were utilized to evaluate the outcomes.
A total of 146 patients were included. The median follow-up was 36.7 months (IQR, 12.5-44.2 months). Among the population, 66 patients (45.2%) received chemotherapy, the remaning (54.8%) received PD-1 inhibitor based therapies, including 56 patients(70.0%) received PD-1 inhibitor combined with chemotherapy (PC) and 24 patients (30.0%) received PD-1 inhibitor monotherapy (PM). Survival analysis shown that patients who received PD-1 inhibitor based therapies had better PFS and OS compared with those treated with other therapy (median PFS, 4.0 vs. 10.0 months, P＜0.001; median OS, 39.5 vs. 24.2 months, P＜0.001). What’s more, patients who treated with PC treatment had a superior survival time than those received PM treatment (median PFS, 10.3 vs. 7.0 months, P＜0.001; median OS, 32.4 vs. 41.6 months, P＜0.001). Subgroup analysis found that the PFS and OS benefit of PC was evident in all subgroups.
For advanced NSCLC patients with EGFR mutations and PD-L1 TPS≥50% who have failed prior EGFR-TKI therapies without T790M mutation, PD-1 inhibitor based treatment could provide a more favorable survival than classical chemotherapy. What's more, compared with PD-1 inhibitor monotherapy, PD-1 inhibitor combined with chemotherapy seems to be the preferred treatment.
The authors.
Shanghai Shenkang Organization.
All authors have declared no conflicts of interest.