Real-World Clinical Impact of Immune Checkpoint Inhibitors in Patients With Advanced/Metastatic Non-Small Cell Lung Cancer After Platinum Chemotherapy

We compared real-world data from US patients who received second-line (2L) therapy for non-small-cell lung cancer before (historical) and after (current) US Food and Drug Administration approval of programmed death ligand 1 (PD-L1) inhibitors. A greater proportion of patients received 2L therapy in the current compared with the historical setting; approximately half of current patients received 2L PD-L1 inhibitors. Survival was improved by 15% in the current setting. Background: The real-world effect of anti-programmed death ligand 1 (PD-L1) therapies is unclear. We compared US patients who received second-line therapy for non-small-cell lung cancer (NSCLC) before and shortly after US Food and Drug Administration (FDA) approval of PD-L1 inhibitors. Patients and Methods: Patients in the Flatiron Health database (>18 years; received first-line platinum therapy for advanced/metastatic NSCLC; >6 months of follow-up) were assessed before (historical: January 1, 2011 to December 31, 2013) and after (current: January 1, 2015 to May 31, 2017) FDA approval of antiePD-L1 therapies for NSCLC. Index was start of second-line therapy. Baseline variables, treatment patterns, and overall survival (OS) were reported. Results: A greater proportion of patients in the current cohort received second-line treatment than in the historical cohort (n = 4240 [57.0%] vs. n = 2357 [37.4%]); 48.8% [n = 2071] of the current second-line patients received antiePD-L1 therapy. Current patients were more likely to receive second-line antiePD-L1 therapy if they had poorer Eastern Cooperative Oncology Group (ECOG) performance status (>= 2), had squamous histology, or had no epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), or ROS proto-oncogene 1 mutations. Median OS from index was higher in the current cohort (9.4 [95% confidence interval (CI), 8.9-9.9] months) than the historical cohort (7.3 [95% CI, 6.9-7.8] months). Adjusted for sex, race, ECOG performance status, disease stage, and Kirsten rat sarcoma viral oncogene homolog, EGFR, and ALK status, OS was improved by 15% in the current cohort. Conclusion: Contemporary patients are more likely to receive second-line therapy and have longer OS than patients who received care before approval of antiePD-L1 therapies. (C) 2019 The Authors. Published by Elsevier Inc.