Efficacy of Pembrolizumab Monotherapy in Patients With or Without Brain Metastases From Advanced Non–Small Cell Lung Cancer With a PD-L1 Expression ≥50%
Giulio Metro, Giuseppe Luigi Banna, Diego Signorelli, Alessio Gili, Domenico Galetta, Giulia Galli, Panagiota Economopoulou, Fausto Roila, Alex Friedlaender, Andrea Camerini, Athina Christopoulou, Ornella Cantale, Alessandro De Toma, Pamela Pizzutilo, Beatriz Jiménez, Ana Collazo-Lorduy, Antonio Calles, Panagiotis Baxevanos, Helena Linardou, P. Kosmidis, Diana Giannarelli, Giannis Mountzios, Alfredo Addeo
Abstract
The authors conducted a multicenter retrospective study on the outcome of programmed death-ligand 1 tumor proportion score≥50% advanced non-small cell lung cancer patients treated with first-line pembrolizumab according to the presence/absence of brain metastases. A total of 282 patients were included, of whom 56 had brain metastases that were treated with upfront local radiation therapy in 80.3% of cases. The overall response rate was 39.2% and 44.4% in patients with and without brain metastases (P=0.48), respectively, while intracranial response rate and intracranial disease control rate were 67.5% and 85.0%, respectively. The median time-to-treatment failure (TTF) and overall survival (OS) were 4.2 and 9.9 months versus 10.8 and 26.5 months for patients with and without brain metastases (P=0.06 and 0.05, respectively). Drug discontinuation rate due to treatment-related adverse events was 10.7% and 10.2% in patients with and without brain metastases, respectively. Multivariate analysis showed that baseline steroids was an independent predictor for a worse OS (P<0.001), while performance status (PS)≥2 was an independent predictor for a poorer TTF (P<0.001) and OS (P<0.001). In patients with brain metastases, only PS ≥2 was predicted for a worse TTF (P=0.02) and OS (P=0.03). Pembrolizumab has activity against brain metastases from non-small cell lung cancers with programmed death-ligand 1≥50%. Presence of brain metastases per se does not appear to be prognostic, and PS ≥2 seems to be the only factor associated with a worse outcome in patients with brain metastases.