Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2019 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Pooled subgroup analysis of twelve randomized controlled trials of immunotherapy in non-small cell lung cancer.
Metastatic Non-Small Cell Lung Cancer
Lung Cancer—Non-Small Cell Metastatic
2019 ASCO Annual Meeting
J Clin Oncol 37, 2019 (suppl; abstr e20639)
Author(s): Fang Yang, Yucai Wang, Aaron Scott Mansfield, Alex A. Adjei, Konstantinos Leventakos, Rutian Li, Jia Wei, Lifeng Wang, Baorui Liu, Julian R. Molina; The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, China; Mayo Clinic, Rochester, MN
Background: Multiple randomized controlled trials (RCTs) have shown a robust benefit of immunotherapy with immune checkpoint inhibitors (ICI) in non-small cell lung cancer (NSCLC). We did a meta-analysis to examine the benefit of ICI in various subgroups. Methods: PubMed was searched up to Jan 15, 2019 for RCTs comparing overall survival (OS) between ICI and control (without ICI) arms. Pooled hazard ratio (HR) and 95% confidence interval (CI) was calculated for each subgroup. Interaction tests were done to compare relative benefit between opposed subgroups of interest (eg. men vs women; reported as Pheterogeneity). All analyses were performed with a random effects model in Comprehensive Meta Analysis (v2). Results: Twelve phase 2/3 RCTs involving 7244 patients were included. A significant OS benefit of ICI was found in both squamous and non-squamous histology. Current/former smokers, EGFR wild-type, and KRAS mutant patients had a significant OS benefit from ICI, but never smokers, EGFR mutant, and KRAS wild-type patients did not. An OS benefit of ICI was found in patients with or without baseline brain metastasis, PD-L1 < 1% or ≥1%, men or women, age < 65 or ≥65, and ECOG PS 0 or ≥1. No significant difference of relative benefit from ICI over control was found in patients with different PD-L1 expression, sex, age, or ECOG PS (Table). Conclusions: OS benefit of ICI in NSCLC was associated with a smoking history, wild-type EGFR or KRAS mutation. However, the OS benefit of ICI was seen regardless of histology, PD-L1 expression, sex, age, and ECOG PS.
|Subgroup||HR (95% CI)||P||HR (95% CI)||P||Pheterogeneity|
|Histology||Squamous||0.74 (0.67-0.83)||< 0.01||Non-squamous||0.72 (0.60-0.88)||0.01||-|
|Smoker||Current/former||0.74 (0.63-0.86)||< 0.01||Never||0.74 (0.46-1.18)||0.20||-|
|EGFR||Mutant||1.12 (0.80-1.56)||0.52||Wild-type||0.67 (0.60-0.76)||< 0.01||-|
|KRAS||Mutant||0.60 (0.39-0.93)||0.02||Wild-type||0.89 (0.68-1.17)||0.40||-|
|Baseline brain metastasis||Yes||0.46 (0.32-0.67)||< 0.01||No||0.65 (0.53-0.81)||< 0.01||0.14|
|PD-L1||< 1%||0.70 (0.59-0.84)||< 0.01||≥1%||0.63 (0.53-0.75)||< 0.01||0.49|
|Sex||Male||0.75 (0.68-0.82)||< 0.01||Female||0.71 (0.55-0.92)||0.08||0.80|
|Age||< 65||0.69 (0.59-0.81)||< 0.01||≥65||0.77 (0.68-0.88)||< 0.01||0.27|
|ECOG PS||0||0.74 (0.64-0.87)||< 0.01||≥1||0.71 (0.62-0.81)||< 0.01||0.59|