Comparison of Chemotherapy Plus Pembrolizumab vs. Chemotherapy Alone in EGFR-Mutant Non-small-Cell Lung Cancer Patients

The efficacy of immune check point inhibitors for non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation is worth investigating. Propensity score matching helped in obtain-ing a matched pair in patients who underwent chemotherapy plus immunotherapy and chemotherapy alone. Chemotherapy plus immunotherapy showed superior efficacy in improving progression-free survival, suggest -ing its potential usefulness for patients with EGFR-mutant NSCLC.Introduction: Platinum doublet chemotherapy is the standard of care in patients with non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation who had disease progression after tyrosine kinase inhibitor (TKI). We aimed to assess immune checkpoint inhibitors efficacy in EGFR-mutant advanced NSCLC.Materials and Methods: We retrospectively reviewed the data of sensitive EGFR-mutant NSCLC patients who progressed after EGFR-TKIs and received platinum doublet chemotherapy plus immunotherapy between 2015 and 2021. Efficacy outcomes, including overall response rate, progression-free survival, and overall survival, were assessed and compared with those of patients who had received platinum-based doublet chemotherapy. Results: Of the total 869 patients, 82 treated with pembrolizumab and chemotherapy and 82 with only chemotherapy were selected. The median progression-free survival in patients administered pembrolizumab was significantly longer than those not admin-istered pembrolizumab (6.7 months; 95% confidence interval [CI] 5.0-8.5 vs. 4.2 months; 95% CI 3.3-5.0, hazard ratio [HR] 0.64, 95% CI 0.46-0.89, P = .0076). Improved median overall survival was also observed in patients receiving pembrolizumab plus chemotherapy (26.7 [95% CI 22.6-30.8] vs. 13.4 months [95% CI 10.4-16.4], HR, 0.49 [95% CI 0.31-0.75], P = .0052). In addition, the overall response rate was higher in patients treated with than patients treated without pembrolizumab (34.1% and 20.7%, respectively). Conclusion: The combination of pembrolizumab with chemotherapy is associated with improved efficacy and survival in patients with EGFR-mutant NSCLC after TKI resistance, but these findings need to be confirmed in further prospective studies.

Automated summary

The efficacy of immune checkpoint inhibitors for EGFR-mutant NSCLC is worth investigating. Propensity score matching showed that chemotherapy plus immunotherapy improved progression-free survival compared to chemotherapy alone, suggesting its potential usefulness for patients with EGFR-mutant NSCLC.