Checkpoint Inhibitor Consolidation Therapy and Adverse Events in Stage III NSCLC

Retrospective studies of patients with stage IV NSCLC who were treated with consolidation checkpoint inhibitor therapy, and who experienced immune-related adverse events (AEs), typically receive fewer cycles of consolidation checkpoint inhibitor therapy with no significant negative impact on efficacy.

Researchers evaluated the association between immune-related AEs and efficacy outcomes from the HCRN LUN 14-179 study, a single-arm phase 2 trial of consolidation pembrolizumab following concurrent chemoradiotherapy (CRT) in patients with unresectable stage III NSCLC. Eligible patients with stage III NSCLC who did not progress after completion of CRT received pembrolizumab 200 mg intravenously (every 3 weeks) for up to 1 year. Demographics, disease characteristics, and number of cycles of pembrolizumab received were reported in patients who had any-grade immune-related AEs, except pneumonitis that included grade ≥2 (Group A) and those without immune-related AEs (except grade 1 pneumonitis) (Group B).

Ninety-two patients eligible for efficacy analysis were enrolled in the study from March 2015 to November 2016. The 4-year overall survival estimate for all patients is 46.2%. Any-grade immune-related AEs (except grade 1 pneumonitis) (N = 37 patients) included pneumonitis (19%), hypothyroidism (14%), hyperthyroidism (11%), increased creatinine (5%), elevated transaminases (3%), and colitis (3%). Grade ≥2 immune-related AEs (N = 32 patients) included pneumonitis (19%), hypothyroidism (11%), and colitis (3%).

Patients in Group A received a median of 9 cycles of pembrolizumab while Group B patients received a median of 14 cycles (P = .15). Four-year efficacy end points in Group A and Group B were time to metastatic disease, 35% versus 41%, respectively (P = .83); progression-free survival, 28% versus 29%, respectively (P = .97); and overall survival, 44% versus 48% (P = .99), respectively.

Researchers concluded that, despite receiving fewer cycles of consolidation pembrolizumab, patients with stage III NSCLC who experienced any-grade immune-related AEs, excluding grade 1 pneumonitis, did not have significantly reduced efficacy outcomes.

Reference

Shukla N, Althouse SK, Sadiq AA, et al. The association between immune-related adverse events and efficacy outcomes with consolidation pembrolizumab after chemoradiation in patients with stage III non-small cell lung cancer: an analysis from HCRN LUN 14-179. J Clin Oncol. 2020;38:suppl (abstract 9032).