Safety and Efficacy of First-Line Pembrolizumab in Black Patients with Metastatic Non-Small-Cell Lung Cancer
Menée à partir de données portant sur 136 patients atteints d'un cancer du poumon non à petites cellules de stade métastatique, cette étude rétrospective évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité du pembrolizumab en traitement de première ligne, en fonction de l'origine ethnique
Résumé en anglais
Introduction : Pembrolizumab, an immune checkpoint inhibitor (ICI), has become an integral part of front‐line treatment of metastatic non‐small‐cell lung cancer (NSCLC). However, pivotal trials had significant underrepresentation of Black patients (pts). Lack of sufficient evidence regarding safety and efficacy of ICIs among minority racial groups poses a challenge in delivery of optimal cancer directed care.
Methods : We retrospectively reviewed pts with stage IV NSCLC treated with first‐line pembrolizumab across three MedStar facilities between January 1st, 2014 and May 31st, 2019. Progression‐free survival (PFS) and overall survival (OS) were primary endpoints and were calculated using the Kaplan‐Meier method. Immune‐related adverse events (irAEs) were assessed according to CTCAE v5.0.
Results : 136 pts were identified with 74 (54.4%) White, 53 (39%) Black, 2 (1.5%) Asian and 7 (5.1%) other racial groups. Median age in White pts was 70 years and 65 years in Black pts (p<0.01). There was no difference in median PFS (5.7 vs 5.9 months, p= 0.651) or OS (11.8 vs 12.4 months, p= 0.949) between White and Black pts. In the subset of patients whose tumors had high programmed death‐ligand 1 (PD‐L1) expression (≥ 50%), there was still no difference in efficacy by race. Median PFS (8.7 vs 3.9 months, p= 0.843) and OS (14.7 vs 11.3 months, p= 0.581) in White versus Black pts were not different. Incidence of irAEs in White versus Black pts was 24.3% and 22.6%, respectively (p=0.83).
Conclusions : We found no major differences in either safety or efficacy of first‐line pembrolizumab between White and Black pts. Use of first‐line pembrolizumab‐based treatment in Black pts with stage IV NSCLC is safe and efficacious, based on these real‐world data.
IMPLICATIONS FOR PRACTICE : Immunotherapy has revolutionized treatment of solid and hematological malignancies. There are certain populations of patients underrepresented in the original trials including minority racial groups, patients with autoimmune diseases and those with chronic viral illnesses. Our study focuses on Black patients with metastatic lung cancer who received pembrolizumab and concludes similar safety and response to treatment when compared to White patients. Black patients are an important demographic group in clinical practice often facing systemic healthcare disparities. Our study paves a path for future studies in underrepresented populations receiving immunotherapy across various malignancies.
