KẾT QUẢ CỦA PHÁC ĐỒ HÓA TRỊ KẾT HỢP  PEMBROLIZUMAB TRONG ĐIỀU TRỊ BƯỚC MỘT BỆNH  NHÂN UNG THƯ PHỔI KHÔNG TẾ BÀO NHỎ GIAI ĐOẠN DI  CĂN XA CÓ PD-L1≥1%, EGFR(-), ALK(-) VÀ ROS1(-)

Luân Phạm Thành; Minh Lê Hồng; Hoạt Phạm Viết; Bắc Vũ Văn; Dũng Nguyễn Tiến; Chiến Trần Khắc; Nga Trần Thị Quỳnh; Huy Lương Trần Quang; Ý Phạm Thị Như

doi:10.59354/ydth175.2024.240

Keywords:

Non-small-cell lung cancer, pembrolizumab

Abstract

Objectives: Evaluating the results of chemotherapy with pembrolizumab in the firstline treatment for patients with distant metastatic non-small cell lung cancer with PD-L1≥1%, EGFR(-), ALK(-) and ROS1(-): overall survival, progression-free survival, treatment-related adverse events.

Subjects and methods: Patients with distant metastatic non-small cell lung cancer with PD-L1≥1%, EGFR(-), ALK(-) and ROS1(-) received chemotherapy plus pembrolizumab as first-line treatment from October 2019 to Feb 2023 at Military Hospital 175 with appropriate inclusion and exclusion criteria. Cohort study, retrospective.

Results: The study enrolled 52 patients with the following characteristics: average age 68.9±18.8; 84.6% are male; 53.8% had PS=1 and 46.2% had PS=2; 78.8% are smoker; pathologic evaluation: adenocarcinoma accounted for 78.8%, squamous cell carcinoma accounted for 21.2%; 48.1% expressed PD-L1 at levels 1-49% and 51.9% showed levels ≥50%; 40.4% had brain metastases from the start of the study, there were 03 chemotherapy regimens selected including 02 regimens for adenocarcinoma: cisplatin/pemetrxed accounted for 38.5%, and carboplatin/ pemetrxed regimen accounted for 38.5% and carboplatin/paclitaxel regimen accounted for 23.1% for patients with squamous cell pathology. Patients received chemotherapy with 4/5/6 cycles with rates of 21.2%/42.3%/36.5% respectively; The rate of adherence to pembrolizumab according to the regimen was 91.9%; Grade 3 or worse adverse events include anemia 15.4%, neutropenia 34.6%, thrombocytopenia 3.8% and interstitial lung disease 3.8%.

Outcomes: mean follow-up 24.0 months, median PFS = 15.0 months (95% CI: 11 to 28), median OS = 23.0 months (95% CI: 18 to 28), patients with high PD-L1 expression levels (≥50%) had significantly higher OS and PFS than the group with low PD-L1 (1-49%) with Logranks test with p values respectively are 0.003 and 0.0018.

Conclusions: Pembrolizumab plus chemotherapy in first-line treatment for patients with distant metastatic non-small-cell lung cancer with PD-L1≥1%, EGFR(-), ALK(-) and ROS1(-) has acceptable toxicity, improves both OS and PFS, especially in patients with high PD-L1 expression levels.

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