Uptake of second-line anticancer therapy after first-line pembrolizumab in patients with stage IV non–small cell lung cancer with PD-L1 > 50%: Comparison between clinical trials and the real world.
Bibliographic record
Abstract
126 Background: In KEYNOTE-024 single agent pembrolizumab was compared to platinum-based chemotherapy in advanced non-small cell lung cancer (NSCLC) with PDL1 >50%. Patients treated with pembrolizumab had an improved progression free survival and overall survival (OS). In KEYNOTE-024, 53% of patients treated with pembrolizumab received second line anticancer therapy with a median OS of 26.3 months. The objective of this study is to characterize real-world NSCLC patients who received second line therapy after pembrolizumab. Methods: A retrospective study of stage IV NSCLC patients with PDL1 >50% referred to BC Cancer between 2018-2021 treated with first line pembrolizumab. Patient demographics, treatment received, and outcomes were collected retrospectively. Baseline characteristics were compared using descriptive statistics. Univariate and multivariate analysis was completed. Kaplan-Meier curves was used to calculate OS and compared using the log rank test. Results: Between 2018-2021, 718 Stage IV NSCLC patients received at least 1 cycle of pembrolizumab. Median duration on treatment was 4.4 months and follow up duration was 16.0 months. 567 (80%) had disease progression of which only 21% (n = 119) received second line systemic therapy. Within the subset with disease progression, median duration on treatment was 3.0 months and follow up duration was 11.7 months. Patients who received second line therapy were younger (p < 0.001), better baseline ECOG PS (p < 0.001) and had longer duration on first line pembrolizumab (p < 0.001). There was no difference in sex (p = 0.519), smoking status (p = 0.416) or histology (p = 0.136). In the multivariate model including age (OR 0.95), baseline ECOG PS (PS 0-1, OR 2.59) and duration on pembrolizumab (OR 1.05) each independently impacted receipt of second line therapy, Table. Median OS from date of diagnosis was 9.6 (IQR 8.4-10.9) months in patients who did not receive additional therapy after progression and 25.3 (IQR 22.5-28.1) months in patients who received subsequent therapy, (p < 0.001). Conclusions: In our stage IV NSCLC population, we found that only 21% of patients received second line systemic therapy despite it being associated with improved OS. Compared to KEYNOTE-024, this real-world population found that 60% less patients received second line systemic therapy. Although differences exist between a clinical and non-clinical trial population, these findings suggest significantly undertreating our stage IV NSCLC patients requiring increased rates of offering second line therapy.[Table: see text]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".