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Erschienen in:

26.04.2023 | Chest

Advanced non-small-cell lung cancer treated with first-line pembrolizumab plus chemotherapy: tumor response dynamics as a marker for survival

verfasst von: Mizuki Nishino, Xinan Wang, Biagio Ricciuti, Shu-Chi Tseng, Hyesun Park, Joao V. Alessi, Victor R. Vaz, Hiroto Hatabu, Xihong Lin, David C. Christiani, Mark M. Awad

Erschienen in: European Radiology | Ausgabe 10/2023

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Abstract

Objectives

The study investigated tumor burden dynamics on computed tomography (CT) scans in patients with advanced non-small-cell lung cancer (NSCLC) during first-line pembrolizumab plus chemotherapy, to provide imaging markers for overall survival (OS).

Methods

The study included 133 patients treated with first-line pembrolizumab plus platinum-doublet chemotherapy. Serial CT scans during therapy were assessed for tumor burden dynamics during therapy, which were studied for the association with OS.

Results

There were 67 responders, with overall response rate of 50%. The tumor burden change at the best overall response ranged from − 100.0% to + 132.1% (median of − 30%). Higher response rates were associated with younger age (p < 0.001) and higher programmed cell death-1 (PD-L1) expression levels (p = 0.01). Eighty-three patients (62%) showed tumor burden below the baseline burden throughout therapy. Using an 8-week landmark analysis, OS was longer in patients with tumor burden below the baseline burden in the first 8 weeks than in those who experienced ≥ 0% increase (median OS: 26.8 vs. 7.6 months, hazard ratio (HR): 0.36, p < 0.001). Tumor burden remained below their baseline throughout therapy was associated with significantly reduced hazards of death (HR: 0.72, p = 0.03) in the extended Cox models, after adjusting for other clinical variables. Pseudoprogression was noted in only one patient (0.8%).

Conclusions

Tumor burden staying below the baseline burden throughout the therapy was predictive of prolonged overall survival in patients with advanced NSCLC treated with first-line pembrolizumab plus chemotherapy, and may be used as a practical marker for therapeutic decisions in this widely used combination regimen.

Clinical relevance statement

The analysis of tumor burden dynamics on serial CT scans in reference to the baseline burden can provide an additional objective guide for treatment decision making in patients treated with first-line pembrolizumab plus chemotherapy for their advanced NSCLC.

Key Points

• Tumor burden remaining below baseline burden during therapy predicted longer survival during first-line pembrolizumab plus chemotherapy.

• Pseudoprogression was noted in 0.8%, demonstrating the rarity of the phenomenon.

• Tumor burden dynamics may serve as an objective marker for treatment benefit to guide treatment decisions during first-line pembrolizumab plus chemotherapy.

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Titel: Advanced non-small-cell lung cancer treated with first-line pembrolizumab plus chemotherapy: tumor response dynamics as a marker for survival
verfasst von: Mizuki Nishino
Xinan Wang
Biagio Ricciuti
Shu-Chi Tseng
Hyesun Park
Joao V. Alessi
Victor R. Vaz
Hiroto Hatabu
Xihong Lin
David C. Christiani
Mark M. Awad
Publikationsdatum: 26.04.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 10/2023
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-09658-1

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Advanced non-small-cell lung cancer treated with first-line pembrolizumab plus chemotherapy: tumor response dynamics as a marker for survival