Efficacy of first-line treatments for advanced pulmonary sarcomatoid carcinomas: a real-world analysis
Karim Amrane, B. Cabarrou, G. Justeau, S. Schneider, Xavier Quantin, L. Falchero, F. Bigot, V. Ferrari, Florian Guisier, N. Girard, H. Léna, Éric Dansin, Anne Madroszyk, Acya Bizieux, D. Debieuvre, M. Pérol, Yannick Simoneau, L. Bosquet, R. Descourt, C. Chouaïd
Abstract
BACKGROUND: Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs). PATIENTS AND METHODS: Using the French Epidemiological Strategy and Medical Economics Lung Cancer (ESME-LC) database (2015-2022), we analyzed APSC patients' first-line ICI ± ChT or ChT outcomes, then applied propensity score weighting to indirectly compare them. RESULTS: Among 42 219 patients with untreated lung cancers, 229 (0.5%) had APSCs. One hundred and sixty-one (70.3%) received first-line treatment (43 ICI alone, 24 ICI + ChT, 94 ChT alone): median age, 66 years; 70.2% men; 69.8% Eastern Cooperative Oncology Group performance status 0/1, among 106 available values; 86.2% smokers or former smokers. Molecular testing was done for 113/161 (70.2%) patients, 35.4% of whom had a molecular abnormality, most frequently a KRAS mutation (39.7%). Programmed death-ligand 1 tumor proportion scores determined for 43.5% of tumors (70/161) were: 68.6% ≥50%, 8.6% 1%-49%, and 22.9% <1%. For the ICI ± ChT group, median PFS and OS were 4.6 months [95% confidence interval (CI) 2.1-8.2 months] and 20.6 months (95% CI 10.3-32.4 months), respectively. For ChT-alone recipients, median PFS and OS were 2.2 months (95% CI 2.0-3.0 months) and 6.8 months (95% CI 4.3-10.0 months), respectively. Applying a propensity score, ICI ± ChT was significantly associated with longer PFS (HR 0.46, 95% CI 0.29-0.72, P < 0.001) and longer OS (HR 0.46, 95% CI 0.28-0.74, P = 0.002) than ChT alone. CONCLUSION: According to this real-world analysis, first-line ICI ± ChT seems to have considerably improved the prognosis of APSCs.