Immune Checkpoint Inhibitors in first versus second line of metastatic non-small cell lung cancer: Real-World Overall Survival

Introduction. Although immuneand targeted therapy have become successful in recent years, platinum-based chemotherapy continues to have a place in the up-front treatment for metastatic non-small cell lung cancer (NSCLC). Aim. Tо evaluate the overall survival (OS) of patients with metastatic NSCLC who were treated with immune checkpoint inhibitors either as first-line or second-line treatment in clinical practice in Russia. Materials and methods. Using real-world database, we retrospectively selected 232 patients with metastatic NSCLC without driving mutations. Of these patients, 82 received chemoimmunotherapy as the initial treatment (group 1) and 150 patients were treated with platinum–based chemotherapy followed by immunotherapy as the second line (group 2). Multivariate subgroup analyses were performed. The median time from the start of treatment to data cut off was 38.4 months. Results. The median OS was the same in the first and second group, 21.0 months (14.4–27.6; 95% CI) and 22.4 months (17.6–27.19; 95% CI); estimated 3-year OS was 40% and 36.6%, respectively. The hazard ratio (HR) for patients in the immunochemotherapy group was 1.02 (0.72–1.44; 95% CI) compared with patients who received second-line immunotherapy. In multivariate analysis, non-compliance with basic inclusion criteria in clinical trials (ECOG 2–3, serious intercurrent illness, active infection, chronic infection, corticosteroids need) (HR = 1.71 (1.21–2.4; 95% CI), the liver metastasis (HR = 1.76 (1.09–2.84; 95% CI) and gender (male vs. female HR = 1.68 (1.04–2.71; 95% DI) were significantly associated with the shorter OS. Conclusions. The overall survival in patients who received immunotherapy in the second line of treatment did not differ from the results of treatment for the patients after immuno-chemotherapy in the first line. The crucial is the receiving of immunotherapy regardless of the line. Failure to meet the criteria of inclusion in clinical trials significantly worsens the long-term outcomes.