Predictive value of PD-L1 and other clinical factors for chemoimmunotherapy in advanced non-small-cell lung cancer

Rachel Woodford; Yanni Loh; Joanna Lee; Wendy Cooper; Ian Marschner; Craig R Lewis; Michael Millward; Sally Lord; Richard J Gralla; James C-H Yang; Tony Mok; Chee K Lee

doi:10.2217/fon-2019-0105

Predictive value of PD-L1 and other clinical factors for chemoimmunotherapy in advanced non-small-cell lung cancer

Future Oncol. 2019 Jul;15(20):2371-2383. doi: 10.2217/fon-2019-0105. Epub 2019 Jun 25.

Authors

Rachel Woodford¹, Yanni Loh¹, Joanna Lee¹, Wendy Cooper^{2

3

4}, Ian Marschner^{5

6}, Craig R Lewis⁷, Michael Millward^{8

9}, Sally Lord^{5

10}, Richard J Gralla¹¹, James C-H Yang¹², Tony Mok¹³, Chee K Lee^{1

5}

Affiliations

¹ Cancer Care Centre, St George Hospital, Kogarah, Sydney, New South Wales 2217, Australia.
² Tissue Pathology & Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales 2050, Australia.
³ Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia.
⁴ School of Medicine, Western Sydney University, Penrith, Sydney, New South Wales 2751, Australia.
⁵ National Health & Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, Sydney, New South Wales 1450, Australia.
⁶ Department of Statistics, Macquarie University, North Ryde, Sydney, New South Wales 2109, Australia.
⁷ Prince of Wales Hospital Clinical School, University of NSW, Randwick, Sydney, New South Wales 2031, Australia.
⁸ School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia.
⁹ Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia 6010, Australia.
¹⁰ School of Medicine, University of Notre Dame, Darlinghurst, Sydney, New South Wales 2010, Australia.
¹¹ Albert Einstein College of Medicine, Jacobi Medical Center, The Bronx, NY 10461, USA.
¹² Graduate Institute of Oncology, National Taiwan University & Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan 10002, Taiwan.
¹³ Department of Clinical Oncology, Hong Kong Cancer Institute, Chinese University of Hong Kong, Shatin NT, PR China.

PMID: 31354046
DOI: 10.2217/fon-2019-0105

Abstract

We investigate if PD-L1 expression and other clinical characteristics predict chemoimmunotherapy (CIT) benefits versus chemotherapy in advanced non-small-cell lung cancer. We performed a meta-analysis of randomized controlled trials of CIT versus chemotherapy identified through electronic searches. In seven randomized controlled trials (n = 4170), CIT prolonged progression-free survival over chemotherapy (hazard ratio [HR]: 0.62; 95% CI: 0.58-0.67; p < 0.00001). The treatment benefits differed between PD-L1-high (HR: 0.41; 95% CI: 0.34-0.49) and PD-L1 low (HR: 0.63; 95% CI: 0.55-0.72; interaction-p = 0.00002) and PD-L1-high and PD-L1-negative (HR: 0.72; 95% CI: 0.65-0.80; interaction-p < 0.00001). Similar benefits were observed regardless of gender, EGFR/ALK status and histological subtype. PD-L1 status is predictive of CIT benefit and may assist patient selection and design of future trials.

Keywords: PD-L1 expression; chemoimmunotherapy; meta-analysis; non-small-cell lung cancer; progression-free survival.

Publication types

Meta-Analysis

MeSH terms

Antineoplastic Agents, Immunological / therapeutic use*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
B7-H1 Antigen / metabolism*
Carcinoma, Non-Small-Cell Lung / drug therapy*
Carcinoma, Non-Small-Cell Lung / mortality
Carcinoma, Non-Small-Cell Lung / pathology
Humans
Lung Neoplasms / drug therapy*
Lung Neoplasms / mortality
Lung Neoplasms / pathology
Neoplasm Staging
Patient Selection
Progression-Free Survival
Randomized Controlled Trials as Topic
Sex Factors

Substances

Antineoplastic Agents, Immunological
B7-H1 Antigen
CD274 protein, human