Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry

Background Pembrolizumab monotherapy is an established front-line treatment for advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) tumor proportion score (TPS)≥50%. However, real-world data on its long-term efficacy remains sparse.Methods This study assessed 5-ye...

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Main Authors: Mieke Van Hemelrijck, Salvatore Grisanti, Avinash Aujayeb, Martin Forster, Giannis Mountzios, Andrea Napolitano, Bruno Vincenzi, Joachim G J V Aerts, Marina Garassino, Valter Torri, Solange Peters, Alex Friedlaender, Alfredo Addeo, Giuseppe Lo Russo, Roberto Ferrara, Diego Signorelli, Alessandro Russo, So Yeon Kim, Jarushka Naidoo, Scott Gettinger, Heather Wakelee, Martin Sebastian, Mark Awad, Abdul Rafeh Naqash, Alessio Cortellini, Raffaele Giusti, Michele De Tursi, Federica Zoratto, Marco Russano, Rita Chiari, Biagio Ricciuti, Andrea De Giglio, Alain Gelibter, Giuseppe Tonini, Amin H Nassar, Alessandra Curioni-Fontecedro, Eleni Karapanagiotou, Emilio Bria, Jack Bell, Paolo Bironzo, Joao V Alessi, Alessandro Morabito, David J Pinato, Francesco Passiglia, Carlo Genova, Francesca Mazzoni, Alessandro Inno, Francesco Grossi, Luca Cantini, Lorenza Landi, Luigi Della Gravara, Margarita Majem, Uma Mukherjee, Federica Biello, Alessandro Leonetti, Annalisa Guida, Marianna Macerelli, Gabriele Minuti, Giulio Metro, Thomas Newsom-Davis, Eleni Josephides, Andrea Camerini, Elisa Roca, David O’Reilly, Mingjia Li, Laura Mezquita, Teresa Gorría, Claudia A M Fulgenzi, Lauren Young, Joel W Neal, Javier Baena, Francesco Pantano, Jacobo Rogado, Mary Jo Fidler, Teresa Beninato, Federica Pecci, Alessandro Di Federico, Kazuki Takada, Leonardo Brunetti, Talal El Zarif, Laura Moliner, Alberto Servetto, Sukumar Kalvapudi, Sai Yendamuri, Edoardo Garbo, Giuseppina Rita Di Fazio, Monica Loza, Ritujith Jayakrishnan, Michele Montrone, Nichola O Awosika, Bartlomiej Tomasik, Maximilian Rost, Isabelle Monnet, Francesco Agustoni, Artur Katz, Dwight Hall Owen, Michele Ghidini, Armida D’Incecco, Gianpaolo Spinelli, Monica Verrico, Manuel Dupont, Rafael Di Marco Barros, Diego Luigi Cortinovis, Chiara Bennati, Frank Aboubakar Nana, Anne-Marie Dingemans, Taher Abu Hejleh
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Language:English
Published: BMJ Publishing Group 2025-02-01
Series:Journal for ImmunoTherapy of Cancer
Online Access:https://jitc.bmj.com/content/13/2/e010674.full
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author Mieke Van Hemelrijck
Salvatore Grisanti
Avinash Aujayeb
Martin Forster
Giannis Mountzios
Andrea Napolitano
Bruno Vincenzi
Joachim G J V Aerts
Marina Garassino
Valter Torri
Solange Peters
Alex Friedlaender
Alfredo Addeo
Giuseppe Lo Russo
Roberto Ferrara
Diego Signorelli
Alessandro Russo
So Yeon Kim
Jarushka Naidoo
Scott Gettinger
Heather Wakelee
Martin Sebastian
Mark Awad
Abdul Rafeh Naqash
Alessio Cortellini
Raffaele Giusti
Michele De Tursi
Federica Zoratto
Marco Russano
Rita Chiari
Biagio Ricciuti
Andrea De Giglio
Alain Gelibter
Giuseppe Tonini
Amin H Nassar
Alessandra Curioni-Fontecedro
Eleni Karapanagiotou
Emilio Bria
Jack Bell
Paolo Bironzo
Joao V Alessi
Alessandro Morabito
David J Pinato
Francesco Passiglia
Carlo Genova
Francesca Mazzoni
Alessandro Inno
Francesco Grossi
Luca Cantini
Lorenza Landi
Luigi Della Gravara
Margarita Majem
Uma Mukherjee
Federica Biello
Alessandro Leonetti
Annalisa Guida
Marianna Macerelli
Gabriele Minuti
Giulio Metro
Thomas Newsom-Davis
Eleni Josephides
Andrea Camerini
Elisa Roca
David O’Reilly
Mingjia Li
Laura Mezquita
Teresa Gorría
Claudia A M Fulgenzi
Lauren Young
Joel W Neal
Javier Baena
Francesco Pantano
Jacobo Rogado
Mary Jo Fidler
Teresa Beninato
Federica Pecci
Alessandro Di Federico
Kazuki Takada
Leonardo Brunetti
Talal El Zarif
Laura Moliner
Alberto Servetto
Sukumar Kalvapudi
Sai Yendamuri
Edoardo Garbo
Giuseppina Rita Di Fazio
Monica Loza
Ritujith Jayakrishnan
Michele Montrone
Nichola O Awosika
Bartlomiej Tomasik
Maximilian Rost
Isabelle Monnet
Francesco Agustoni
Artur Katz
Dwight Hall Owen
Michele Ghidini
Armida D’Incecco
Gianpaolo Spinelli
Monica Verrico
Manuel Dupont
Rafael Di Marco Barros
Diego Luigi Cortinovis
Chiara Bennati
Frank Aboubakar Nana
Anne-Marie Dingemans
Taher Abu Hejleh
author_facet Mieke Van Hemelrijck
Salvatore Grisanti
Avinash Aujayeb
Martin Forster
Giannis Mountzios
Andrea Napolitano
Bruno Vincenzi
Joachim G J V Aerts
Marina Garassino
Valter Torri
Solange Peters
Alex Friedlaender
Alfredo Addeo
Giuseppe Lo Russo
Roberto Ferrara
Diego Signorelli
Alessandro Russo
So Yeon Kim
Jarushka Naidoo
Scott Gettinger
Heather Wakelee
Martin Sebastian
Mark Awad
Abdul Rafeh Naqash
Alessio Cortellini
Raffaele Giusti
Michele De Tursi
Federica Zoratto
Marco Russano
Rita Chiari
Biagio Ricciuti
Andrea De Giglio
Alain Gelibter
Giuseppe Tonini
Amin H Nassar
Alessandra Curioni-Fontecedro
Eleni Karapanagiotou
Emilio Bria
Jack Bell
Paolo Bironzo
Joao V Alessi
Alessandro Morabito
David J Pinato
Francesco Passiglia
Carlo Genova
Francesca Mazzoni
Alessandro Inno
Francesco Grossi
Luca Cantini
Lorenza Landi
Luigi Della Gravara
Margarita Majem
Uma Mukherjee
Federica Biello
Alessandro Leonetti
Annalisa Guida
Marianna Macerelli
Gabriele Minuti
Giulio Metro
Thomas Newsom-Davis
Eleni Josephides
Andrea Camerini
Elisa Roca
David O’Reilly
Mingjia Li
Laura Mezquita
Teresa Gorría
Claudia A M Fulgenzi
Lauren Young
Joel W Neal
Javier Baena
Francesco Pantano
Jacobo Rogado
Mary Jo Fidler
Teresa Beninato
Federica Pecci
Alessandro Di Federico
Kazuki Takada
Leonardo Brunetti
Talal El Zarif
Laura Moliner
Alberto Servetto
Sukumar Kalvapudi
Sai Yendamuri
Edoardo Garbo
Giuseppina Rita Di Fazio
Monica Loza
Ritujith Jayakrishnan
Michele Montrone
Nichola O Awosika
Bartlomiej Tomasik
Maximilian Rost
Isabelle Monnet
Francesco Agustoni
Artur Katz
Dwight Hall Owen
Michele Ghidini
Armida D’Incecco
Gianpaolo Spinelli
Monica Verrico
Manuel Dupont
Rafael Di Marco Barros
Diego Luigi Cortinovis
Chiara Bennati
Frank Aboubakar Nana
Anne-Marie Dingemans
Taher Abu Hejleh
author_sort Mieke Van Hemelrijck
collection DOAJ
description Background Pembrolizumab monotherapy is an established front-line treatment for advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) tumor proportion score (TPS)≥50%. However, real-world data on its long-term efficacy remains sparse.Methods This study assessed 5-year outcomes of first-line pembrolizumab monotherapy in a large, multicenter, real-world cohort of patients with advanced NSCLC and PD-L1 TPS≥50%, referred to as Pembro-real 5Y. Individual patient-level data (IPD) from the experimental arm of the KEYNOTE-024 trial were extracted (KN024 IPD cohort) to compare the long-term outcomes between the two cohorts. To further assess the reproducibility of clinical trial results, we reconstructed the “KN024 look-alike” cohort by excluding patients with an Eastern Cooperative Oncology Group-performance status (ECOG-PS)≥2, those requiring corticosteroids with doses ≥10 mg of prednisolone/equivalent, patients with positive/unknown epidermal growth factor receptor/anaplastic lymphoma kinase genotype, and those with pre-existing autoimmune disease. We additionally provided a hierarchical organization of determinants of long-term benefit through a conditional inference tree analysis.Results The study included 1050 patients from 61 institutions across 14 countries, with a median follow-up of 70.3 months. The 5-year survival rate was 26.9% (95% CI: 23.8% to 30.2%), and median OS was 21.8 months (95% CI: 19.1 to 25.7), while 32 (3.0%) patients who achieved a complete response remained progression-free at the data cut-off. The KN024 look-alike cohort had a 5-year survival rate of 29.3% (95% CI: 25.5% to 33.6%) and a median OS of 27.5 months (95% CI: 22.8 to 31.3). Neither the overall study population nor the KN024 look-alike cohort exhibited significantly different OS compared with the KN024 IPD cohort. By the data cut-off, 1015 patients (96.7%) had permanently discontinued treatment: 659 (64.9%) due to progressive disease, 156 (15.4%) due to toxicity, 77 (7.6%) due to treatment completion, and 106 (10.4%) due to other reasons. Overall, 222 participants (21.1%) were treated for a minimum period of 24 months, among them the 5-year survival rates were: 31.7%, 72.7%, 78.6%, 84.2% for patients who discontinued treatment due to progressive disease, toxicity, treatment completion, and other reasons, respectively.Conclusion This study provides valuable real-world evidence that confirms the long-term efficacy of pembrolizumab outside of clinical trials. Hierarchical organization indicates ECOG-PS, age and PD-L1-TPS as the most important predictors of 5-year survival, potentially informing clinical practice.
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spelling doaj-art-cfc4d8473e7c465aa0bb0b93092e1b132025-02-05T04:10:09ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262025-02-0113210.1136/jitc-2024-010674Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registryMieke Van Hemelrijck0Salvatore Grisanti1Avinash Aujayeb2Martin Forster3Giannis Mountzios4Andrea Napolitano5Bruno Vincenzi6Joachim G J V Aerts7Marina Garassino8Valter Torri9Solange Peters10Alex Friedlaender11Alfredo Addeo12Giuseppe Lo Russo13Roberto Ferrara14Diego Signorelli15Alessandro Russo16So Yeon Kim17Jarushka Naidoo18Scott Gettinger19Heather Wakelee20Martin Sebastian21Mark Awad22Abdul Rafeh Naqash23Alessio Cortellini24Raffaele Giusti25Michele De Tursi26Federica Zoratto27Marco Russano28Rita Chiari29Biagio Ricciuti30Andrea De Giglio31Alain Gelibter32Giuseppe Tonini33Amin H Nassar34Alessandra Curioni-Fontecedro35Eleni Karapanagiotou36Emilio Bria37Jack Bell38Paolo Bironzo39Joao V Alessi40Alessandro Morabito41David J Pinato42Francesco Passiglia43Carlo Genova44Francesca Mazzoni45Alessandro Inno46Francesco Grossi47Luca Cantini48Lorenza Landi49Luigi Della Gravara50Margarita Majem51Uma Mukherjee52Federica Biello53Alessandro Leonetti54Annalisa Guida55Marianna Macerelli56Gabriele Minuti57Giulio Metro58Thomas Newsom-Davis59Eleni Josephides60Andrea Camerini61Elisa Roca62David O’Reilly63Mingjia Li64Laura Mezquita65Teresa Gorría66Claudia A M Fulgenzi67Lauren Young68Joel W Neal69Javier Baena70Francesco Pantano71Jacobo Rogado72Mary Jo Fidler73Teresa Beninato74Federica Pecci75Alessandro Di Federico76Kazuki Takada77Leonardo Brunetti78Talal El Zarif79Laura Moliner80Alberto Servetto81Sukumar Kalvapudi82Sai Yendamuri83Edoardo Garbo84Giuseppina Rita Di Fazio85Monica Loza86Ritujith Jayakrishnan87Michele Montrone88Nichola O Awosika89Bartlomiej Tomasik90Maximilian Rost91Isabelle Monnet92Francesco Agustoni93Artur Katz94Dwight Hall Owen95Michele Ghidini96Armida D’Incecco97Gianpaolo Spinelli98Monica Verrico99Manuel Dupont100Rafael Di Marco Barros101Diego Luigi Cortinovis102Chiara Bennati103Frank Aboubakar Nana104Anne-Marie Dingemans105Taher Abu Hejleh106Medical Oncology Guy`s and St Thomas` Hospitals NHS Trust, London, UKDepartment of Medical and Surgical Specialties Radiological Sciences, and Public Health, University of Brescia, Brescia, ItalyDepartment of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UKThe UCL Cancer Institute, University College London Hospitals NHS Trust, London, UK4th Department of Medical Oncology and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, GreeceSarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UKOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyDepartment of Pulmonary Medicine, Erasmus MC Cancer Institute University Medical Center, Rotterdam, NetherlandsDepartment of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USADepartment of Clinical Oncology, Mario Negri Institute for Pharmacological Research- IRCCS, Milan, ItalyCentre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, SwitzerlandClinique Générale Beaulieu, Geneva, SwitzerlandOncology Service, University Hospital of Geneva, Geneva, SwitzerlandMedical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, ItalyUniversità Vita-Salute San Raffaele, Milan, ItalyNiguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, ItalyMedical Oncology Department, Humanitas Istituto Clinico Catanese, Misterbianco, ItalySection of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USADepartment of Oncology, Beaumont Hospital, Beaumont RCSI Cancer Centre, Dublin, IrelandSection of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USADepartment of Medicine Stanford Cancer Institute, Division of Oncology Stanford University, Stanford, California, USADepartment of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, GermanyLowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USAMedical Oncology/TSET Phase 1 Program, The University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USAOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyMedical Oncology, Sant`Andrea Hospital, Rome, ItalyDepartment of Innovative Technologies in Medicine & Dentistry, University G. D`Annunzio, Chieti-Pescara, Chieti, ItalyOspedale Santa Maria Goretti, Latina, ItalyOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyUOC Oncologia, AST Pesaro - Urbino, Pesaro, ItalyLowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USADepartment of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyDepartment of Clinical and Molecular Oncology, Sapienza University of Rome, Rome, ItalyOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalySection of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USAClinic of Oncology, Cantonal Hospital Fribourg, Faculty of Science and Medicine, University of Fribourg, Fribourg, SwitzerlandMedical Oncology Guy`s and St Thomas` Hospitals NHS Trust, London, UKUniversità Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Oncology, Beaumont Hospital, Beaumont RCSI Cancer Centre, Dublin, IrelandDepartment of Oncology, University of Turin, San Luigi Hospital, Orbassano, ItalyLowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USAThoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, ItalyDepartment of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UKDepartment of Oncology, University of Turin, San Luigi Hospital, Orbassano, ItalyAcademic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, ItalyMedical Oncology, Careggi University Hospital, Florence, ItalyMedical Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, ItalyMedical Oncology Division, Department of Medicine and Technological Innovation, University of Insubria, Varese, ItalyFortrea Inc, Durham, North Carolina, USAClinical Trials Center: Phase 1 and Precision Medicine, IRCCS National Cancer Institute Regina Elena, Rome, ItalyDepartment of Pulmonary Oncology, AORN dei Colli Monaldi, Naples, ItalyDepartment of Medical Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, SpainThe UCL Cancer Institute, University College London Hospitals NHS Trust, London, UKTranslational Medicine Department, University of Eastern Piedmont, AOU Maggiore della Carità Hospital, Novara, ItalyMedical Oncology Unit, University Hospital of Parma, Parma, ItalySC Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Terni, ItalyDepartment of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, ItalyClinical Trials Center: Phase 1 and Precision Medicine, IRCCS National Cancer Institute Regina Elena, Rome, ItalyMedical Oncology, Santa Maria Della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, ItalyDepartment of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UKMedical Oncology Guy`s and St Thomas` Hospitals NHS Trust, London, UKMedical Oncology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, ItalyOncologia Toracica - Lung Unit, Ospedale P. Pederzoli, Peschiera del Garda, ItalyDepartment of Oncology, Beaumont Hospital, Beaumont RCSI Cancer Centre, Dublin, IrelandDivision of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USAMedical Oncology Department, Hospital Clinic of Barcelona, Barcelona, SpainMedical Oncology Department, Hospital Clinic of Barcelona, Barcelona, SpainDepartment of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UKDepartment of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USADepartment of Medicine Stanford Cancer Institute, Division of Oncology Stanford University, Stanford, California, USAHospital Universitario 12 de Octubre, Madrid, SpainOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyMedical Oncology Department, Hospital Universitario Infanta Lenor, Madrid, SpainDivision of Hematology/Oncology/Stem cell transplant, Rush University Medical Center, Chicago, Illinois, USAMedical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, ItalyLowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USALowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USADepartment of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, JapanOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalySection of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USADepartment of Medical Oncology, Catalan Institute of Oncology, L`Hospitalet de Llobregat, SpainDepartment of Clinical Medicine and Surgery, University of Naples Federico II, Naples, ItalyDepartment of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USADepartment of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USALowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USAOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyDepartment of Medicine Stanford Cancer Institute, Division of Oncology Stanford University, Stanford, California, USASection of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USAMedical Thoracic Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, ItalyDepartment of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UKDepartment of Oncology and Radiotherapy, Medical University of Gdańsk, Gdansk, PolandDepartment of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, GermanyService de Pneumologie, Centre Hospitalier Intercommunal, Creteil, FranceMedical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, ItalyOncology Center, Hospital Sírio-Libanês, Sao Paulo, Sao Paulo, BrazilDivision of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USAMedical Oncology, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Milan, ItalyG Mazzini Hospital of Teramo, Teramo, ItalyUOC Territorial Oncology, AUSL Latina (Aprilia), Aprilia, ItalyUOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I, Rome, ItalyClinic of Oncology, Cantonal Hospital Fribourg, Faculty of Science and Medicine, University of Fribourg, Fribourg, SwitzerlandMedical Oncology Guy`s and St Thomas` Hospitals NHS Trust, London, UKDivision of Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori di Monza, Monza, ItalyDepartment of Onco-Hematology, AUSL della Romagna, Ravenna, ItalyDivision of Pneumology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Pulmonary Medicine, Erasmus MC Cancer Institute University Medical Center, Rotterdam, NetherlandsDepartment of Internal Medicine, Medical Oncology, King Hussein Cancer Center, Amman, JordanBackground Pembrolizumab monotherapy is an established front-line treatment for advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) tumor proportion score (TPS)≥50%. However, real-world data on its long-term efficacy remains sparse.Methods This study assessed 5-year outcomes of first-line pembrolizumab monotherapy in a large, multicenter, real-world cohort of patients with advanced NSCLC and PD-L1 TPS≥50%, referred to as Pembro-real 5Y. Individual patient-level data (IPD) from the experimental arm of the KEYNOTE-024 trial were extracted (KN024 IPD cohort) to compare the long-term outcomes between the two cohorts. To further assess the reproducibility of clinical trial results, we reconstructed the “KN024 look-alike” cohort by excluding patients with an Eastern Cooperative Oncology Group-performance status (ECOG-PS)≥2, those requiring corticosteroids with doses ≥10 mg of prednisolone/equivalent, patients with positive/unknown epidermal growth factor receptor/anaplastic lymphoma kinase genotype, and those with pre-existing autoimmune disease. We additionally provided a hierarchical organization of determinants of long-term benefit through a conditional inference tree analysis.Results The study included 1050 patients from 61 institutions across 14 countries, with a median follow-up of 70.3 months. The 5-year survival rate was 26.9% (95% CI: 23.8% to 30.2%), and median OS was 21.8 months (95% CI: 19.1 to 25.7), while 32 (3.0%) patients who achieved a complete response remained progression-free at the data cut-off. The KN024 look-alike cohort had a 5-year survival rate of 29.3% (95% CI: 25.5% to 33.6%) and a median OS of 27.5 months (95% CI: 22.8 to 31.3). Neither the overall study population nor the KN024 look-alike cohort exhibited significantly different OS compared with the KN024 IPD cohort. By the data cut-off, 1015 patients (96.7%) had permanently discontinued treatment: 659 (64.9%) due to progressive disease, 156 (15.4%) due to toxicity, 77 (7.6%) due to treatment completion, and 106 (10.4%) due to other reasons. Overall, 222 participants (21.1%) were treated for a minimum period of 24 months, among them the 5-year survival rates were: 31.7%, 72.7%, 78.6%, 84.2% for patients who discontinued treatment due to progressive disease, toxicity, treatment completion, and other reasons, respectively.Conclusion This study provides valuable real-world evidence that confirms the long-term efficacy of pembrolizumab outside of clinical trials. Hierarchical organization indicates ECOG-PS, age and PD-L1-TPS as the most important predictors of 5-year survival, potentially informing clinical practice.https://jitc.bmj.com/content/13/2/e010674.full
spellingShingle Mieke Van Hemelrijck
Salvatore Grisanti
Avinash Aujayeb
Martin Forster
Giannis Mountzios
Andrea Napolitano
Bruno Vincenzi
Joachim G J V Aerts
Marina Garassino
Valter Torri
Solange Peters
Alex Friedlaender
Alfredo Addeo
Giuseppe Lo Russo
Roberto Ferrara
Diego Signorelli
Alessandro Russo
So Yeon Kim
Jarushka Naidoo
Scott Gettinger
Heather Wakelee
Martin Sebastian
Mark Awad
Abdul Rafeh Naqash
Alessio Cortellini
Raffaele Giusti
Michele De Tursi
Federica Zoratto
Marco Russano
Rita Chiari
Biagio Ricciuti
Andrea De Giglio
Alain Gelibter
Giuseppe Tonini
Amin H Nassar
Alessandra Curioni-Fontecedro
Eleni Karapanagiotou
Emilio Bria
Jack Bell
Paolo Bironzo
Joao V Alessi
Alessandro Morabito
David J Pinato
Francesco Passiglia
Carlo Genova
Francesca Mazzoni
Alessandro Inno
Francesco Grossi
Luca Cantini
Lorenza Landi
Luigi Della Gravara
Margarita Majem
Uma Mukherjee
Federica Biello
Alessandro Leonetti
Annalisa Guida
Marianna Macerelli
Gabriele Minuti
Giulio Metro
Thomas Newsom-Davis
Eleni Josephides
Andrea Camerini
Elisa Roca
David O’Reilly
Mingjia Li
Laura Mezquita
Teresa Gorría
Claudia A M Fulgenzi
Lauren Young
Joel W Neal
Javier Baena
Francesco Pantano
Jacobo Rogado
Mary Jo Fidler
Teresa Beninato
Federica Pecci
Alessandro Di Federico
Kazuki Takada
Leonardo Brunetti
Talal El Zarif
Laura Moliner
Alberto Servetto
Sukumar Kalvapudi
Sai Yendamuri
Edoardo Garbo
Giuseppina Rita Di Fazio
Monica Loza
Ritujith Jayakrishnan
Michele Montrone
Nichola O Awosika
Bartlomiej Tomasik
Maximilian Rost
Isabelle Monnet
Francesco Agustoni
Artur Katz
Dwight Hall Owen
Michele Ghidini
Armida D’Incecco
Gianpaolo Spinelli
Monica Verrico
Manuel Dupont
Rafael Di Marco Barros
Diego Luigi Cortinovis
Chiara Bennati
Frank Aboubakar Nana
Anne-Marie Dingemans
Taher Abu Hejleh
Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry
Journal for ImmunoTherapy of Cancer
title Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry
title_full Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry
title_fullStr Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry
title_full_unstemmed Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry
title_short Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry
title_sort determinants of 5 year survival in patients with advanced nsclc with pd l1≥50 treated with first line pembrolizumab outside of clinical trials results from the pembro real 5y global registry
url https://jitc.bmj.com/content/13/2/e010674.full
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