Pembrolizumab well tolerated, improves outcomes in NSCLC patients with autoimmune disease

Use of pembrolizumab is well tolerated in nonsmall cell lung cancer (NSCLC) patients with previous autoimmune diseases, with a nonsignificant trend toward improved outcomes, reports a study.

In addition, completing the course of pembrolizumab is associated with better survival outcomes compared with noncompletion of the treatment.

A team of investigators conducted a retrospective case record review of 82 patients with tumours expressing programmed death-ligand 1 (PD-L1) with tumour proportion score (TPS) of ≥50 percent and treated with first-line pembrolizumab. The Kaplan-Meier method was used to estimate survival.

Median overall survival (OS) after follow-up (median 36.93 months) was 13.6 months (95 percent confidence interval [CI], 8.9‒19.3). Ten patients (12 percent) presented with autoimmune comorbidities. A trend toward better median OS was observed in this group compared with those without autoimmune comorbidity (42 vs 10.7 months; p=0.073).

Notably, 16 patients (20 percent) with nonprogressive disease at 2 years showed significantly better median OS than those who did not complete treatment (p<0.001).

More patients with autoimmune comorbidity developed immune-related adverse events (irAE) compared with those without (90 percent vs 70.8 percent). The only irAE that occurred at a significantly higher rate in the autoimmune group was low-grade adrenal insufficiency (p=0.02).

“Pembrolizumab, an immune-checkpoint inhibitor, is approved for first-line treatment of metastatic NSCLC in patients with tumours expressing PD-L1 with TPS of ≥50 percent,” the investigators noted.