Real-world study of PD-1/L1 immune checkpoint inhibitors for advanced non-small cell lung cancer after resistance to EGFR-TKIs

Kunchen Wei; Chao Zhou; Yang Chen; Xiao Feng; Hao Tang

doi:10.3389/fonc.2023.1217872

Real-world study of PD-1/L1 immune checkpoint inhibitors for advanced non-small cell lung cancer after resistance to EGFR-TKIs

Front Oncol. 2023 Jul 18:13:1217872. doi: 10.3389/fonc.2023.1217872. eCollection 2023.

Authors

Kunchen Wei¹, Chao Zhou¹, Yang Chen¹, Xiao Feng¹, Hao Tang¹

Affiliation

¹ Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Navy Medical University, Shanghai, China.

Abstract

Background: Programmed cell death-1 (PD-1) and its ligand 1 (PD-L1) inhibitors have achieved good efficacy and safety in patients with advanced EGFR mutation-negative non-small cell lung cancer (NSCLC), but their efficacy in patients with previous EGFR mutations is limited. The aim of the present study was to explore the efficacy of PD-1/L1 immune checkpoint inhibitors for the treatment of patients with advanced NSCLC who are resistant to EGFR-TKIs.

Methods: This retrospective study included 123 patients with stage IV NSCLC who received treatment in Shanghai Changzheng Hospital between January 2019 and January 2022 after failure of first-line EGFR-TKIs. Of them, 39 received ICIs + chemotherapy and anti-angiogenic drugs (ICIs+BCP group), 51 received ICIs monotherapy (ICIs group), and 33 received chemotherapy and anti-angiogenic drugs (BCP group). The gender, age, smoking history, ECOG score, EGFR mutation type, PD-L1 TPS expression, and the first routine blood index before second-line treatment of all enrolled patients were recorded, and their clinical outcomes and prognosis factors were analyzed.

Results: There was no significant difference in the objective response rate (ORR) and disease control rate (DCR) between the three groups. Patients in ICIs+BCP group had better prognosis than those in ICIs monotherapy group (PFS:9.5 vs. 4.64 months, p<0.001; OS: 16.97 vs. 7.9 months p<0.001) or BCP group (9.5 vs. 6.48 months, p<0.005; OS: 16.97 vs. 11.39 months p<0.005).

Conclusion: Our findings suggest that in the real-world practice in China, PD-1/L1 immune checkpoint inhibitors combined with chemotherapy and anti-angiogenic drugs are effective for the treatment of patients with advanced NSCLC who are resistant to EGFR-TKIs.

Keywords: EGFR TKI resistance; epidermal growth factor receptor; immune checkpoint inhibitor; nomogram; non-small cell lung cancer.

Grants and funding

The research was sponsored by “Shuguang Program” supported by Shanghai Education Development Foundation and Shanghai Municipal Education Commission (20SG38); Shanghai Municipal Science and Technology Committee of Shanghai Outstanding Academic Leaders Plan (20XD1423300); and the General Program of National Nature Science Foundation of China (No. 82070036).