Prediction of Disease Progression to Upfront Pembrolizumab Monotherapy in Advanced Non-Small-Cell Lung Cancer with High PD-L1 Expression Using Baseline CT Disease Quantification and Smoking Pack Years

Authors

Ali Silver
Cheryl Ho
Qian Ye
Jianjun Zhang
Ian Janzen
Jessica Li
Montgomery Martin
Lang Wu
Ying Wang
Stephen Lam
Calum MacAulay
Barbara Melosky
Ren Yuan

Publication Date

6-8-2023

Journal

Current Oncology

Abstract

Health Canada approved pembrolizumab in the first-line setting for advanced non-small-cell lung cancer with PD-L1 ≥ 50% and no EGFR/ALK aberration. The keynote 024 trial showed 55% of such patients progress with pembrolizumab monotherapy. We propose that the combination of baseline CT and clinical factors can help identify those patients who may progress. In 138 eligible patients from our institution, we retrospectively collected their baseline variables, including baseline CT findings (primary lung tumor size and metastatic site), smoking pack years, performance status, tumor pathology, and demographics. The treatment response was assessed via RECIST 1.1 using the baseline and first follow-up CT. Associations between the baseline variables and progressive disease (PD) were tested by logistic regression analyses. The results showed 46/138 patients had PD. The baseline CT "number of involved organs" by metastasis and smoking pack years were independently associated with PD (p < 0.05), and the ROC analysis showed a good performance of the model that integrated these variables in predicting PD (AUC: 0.79). This pilot study suggests that the combination of baseline CT disease and smoking PY can identify who may progress on pembrolizumab monotherapy and can potentially facilitate decision-making for the optimal first-line treatment in the high PD-L1 cohort.

Keywords

Humans, B7-H1 Antigen, Carcinoma, Non-Small-Cell Lung, Disease Progression, Lung Neoplasms, Pilot Projects, Retrospective Studies, Smoking, Tomography, X-Ray Computed, non-small-cell lung cancer, baseline CT, smoking pack years, pembrolizumab, tumor response, survival, PDL1

DOI

10.3390/curroncol30060419

PMID

37366902

PMCID

PMC10297400

PubMedCentral® Posted Date

6-8-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes