The effect of tumor size and metastatic extent on the efficacy of first line pembrolizumab monotherapy in patients with high PD-L1 expressing advanced NSCLC tumors

Alexandra Schakenraad; S.M.S. Hashemi; J.W.R. Twisk; I. Houda; E.B. Ulas; J.M.A. Daniels; J.D. Veltman; I. Bahce

doi:https://doi.org/10.1016/j.lungcan.2021.10.002

The effect of tumor size and metastatic extent on the efficacy of first line pembrolizumab monotherapy in patients with high PD-L1 expressing advanced NSCLC tumors

Alexandra Schakenraad, S.M.S. Hashemi, J.W.R. Twisk, I. Houda, E.B. Ulas, J.M.A. Daniels, J.D. Veltman, I. Bahce

Research output: Contribution to journal › Article › Academic › peer-review

3 Citations (Scopus)

Abstract

Background: Tumor size and metastatic extent may influence tumor response to immunotherapy in non-small cell lung cancer (NSCLC). The aim of this study was to examine the relationship between both baseline sum of longest diameters (bSLD) and number of metastatic organs (NMO) and the tumor response to pembrolizumab. Secondly, we aimed to analyze the association of baseline SLD and NMO with progression-free survival (PFS) and overall survival (OS).
Methods: This retrospective study included patients with high PD-L1 expressing tumors (≥50%) and a good performance score (ECOG ≤ 2) that received first-line pembrolizumab monotherapy. Tumor response was calculated as the ‘SLD-change score’ and ‘early treatment discontinuation’ within 3 months on therapy (ETD). The relationship of both bSLD (based on RECIST v1.1) and NMO with tumor response and survival outcome (PFS, OS) was evaluated.
Results: No significant differences in SLD-change score could be found using bSLD (OR = 1.010, 95%CI = 0.999–1.021), or using NMO at baseline (OR = 1.608, 95%CI = 0.943–2.743). A bSLD cut-off value of 90 mm was found to be most distinctive for ETD. This cut-off value showed a significant difference for PFS (HR = 2.28, 95%CI = 1.12–4.64, p = 0.023) and OS (HR = 2.99, 95%CI = 1.41–6.34, p = 0.004). NMO also showed a difference for PFS and OS, however, not statistically significant.
Conclusions: Tumor size and metastatic extent could not discriminate for tumor response, however, a bSLD of 90 mm could differentiate for PFS and OS.

Original language	English
Pages (from-to)	36-41
Number of pages	6
Journal	Lung Cancer
Volume	162
DOIs	https://doi.org/10.1016/j.lungcan.2021.10.002
Publication status	Published - 5 Oct 2021

Keywords

Check point inhibitors
Immunotherapy
Non-small cell lung cancer
PD-L1
RECIST
Tumor volume

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@article{9f27429b6a234d0f9d609ddab60db587,

title = "The effect of tumor size and metastatic extent on the efficacy of first line pembrolizumab monotherapy in patients with high PD-L1 expressing advanced NSCLC tumors",

abstract = "Background: Tumor size and metastatic extent may influence tumor response to immunotherapy in non-small cell lung cancer (NSCLC). The aim of this study was to examine the relationship between both baseline sum of longest diameters (bSLD) and number of metastatic organs (NMO) and the tumor response to pembrolizumab. Secondly, we aimed to analyze the association of baseline SLD and NMO with progression-free survival (PFS) and overall survival (OS).Methods: This retrospective study included patients with high PD-L1 expressing tumors (≥50%) and a good performance score (ECOG ≤ 2) that received first-line pembrolizumab monotherapy. Tumor response was calculated as the {\textquoteleft}SLD-change score{\textquoteright} and {\textquoteleft}early treatment discontinuation{\textquoteright} within 3 months on therapy (ETD). The relationship of both bSLD (based on RECIST v1.1) and NMO with tumor response and survival outcome (PFS, OS) was evaluated.Results: No significant differences in SLD-change score could be found using bSLD (OR = 1.010, 95%CI = 0.999–1.021), or using NMO at baseline (OR = 1.608, 95%CI = 0.943–2.743). A bSLD cut-off value of 90 mm was found to be most distinctive for ETD. This cut-off value showed a significant difference for PFS (HR = 2.28, 95%CI = 1.12–4.64, p = 0.023) and OS (HR = 2.99, 95%CI = 1.41–6.34, p = 0.004). NMO also showed a difference for PFS and OS, however, not statistically significant.Conclusions: Tumor size and metastatic extent could not discriminate for tumor response, however, a bSLD of 90 mm could differentiate for PFS and OS.",

keywords = "Check point inhibitors, Immunotherapy, Non-small cell lung cancer, PD-L1, RECIST, Tumor volume",

author = "Alexandra Schakenraad and S.M.S. Hashemi and J.W.R. Twisk and I. Houda and E.B. Ulas and J.M.A. Daniels and J.D. Veltman and I. Bahce",

note = "Funding Information: We thank the Paulien van Deutekom Foundation for their collaboration, which led to the initiation of present study. Conception and design: AS, JV, IB. Provision of study material or patients: SH, JV, HD, IB. Collection and assembly of data: AS, EU, IH. Data analysis and interpretation: AS, JT, IB. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors. Ethical approval, All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent, Informed consent was obtained from all individual participants included in the study. Conflict of interest, The authors have no conflict of interest to disclose. Funding, This work was not supported by external funders. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = oct,

day = "5",

doi = "https://doi.org/10.1016/j.lungcan.2021.10.002",

language = "English",

volume = "162",

pages = "36--41",

journal = "Lung Cancer",

issn = "0169-5002",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - The effect of tumor size and metastatic extent on the efficacy of first line pembrolizumab monotherapy in patients with high PD-L1 expressing advanced NSCLC tumors

AU - Schakenraad, Alexandra

AU - Hashemi, S.M.S.

AU - Twisk, J.W.R.

AU - Houda, I.

AU - Ulas, E.B.

AU - Daniels, J.M.A.

AU - Veltman, J.D.

AU - Bahce, I.

N1 - Funding Information: We thank the Paulien van Deutekom Foundation for their collaboration, which led to the initiation of present study. Conception and design: AS, JV, IB. Provision of study material or patients: SH, JV, HD, IB. Collection and assembly of data: AS, EU, IH. Data analysis and interpretation: AS, JT, IB. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors. Ethical approval, All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent, Informed consent was obtained from all individual participants included in the study. Conflict of interest, The authors have no conflict of interest to disclose. Funding, This work was not supported by external funders. Publisher Copyright: © 2021 The Authors

PY - 2021/10/5

Y1 - 2021/10/5

N2 - Background: Tumor size and metastatic extent may influence tumor response to immunotherapy in non-small cell lung cancer (NSCLC). The aim of this study was to examine the relationship between both baseline sum of longest diameters (bSLD) and number of metastatic organs (NMO) and the tumor response to pembrolizumab. Secondly, we aimed to analyze the association of baseline SLD and NMO with progression-free survival (PFS) and overall survival (OS).Methods: This retrospective study included patients with high PD-L1 expressing tumors (≥50%) and a good performance score (ECOG ≤ 2) that received first-line pembrolizumab monotherapy. Tumor response was calculated as the ‘SLD-change score’ and ‘early treatment discontinuation’ within 3 months on therapy (ETD). The relationship of both bSLD (based on RECIST v1.1) and NMO with tumor response and survival outcome (PFS, OS) was evaluated.Results: No significant differences in SLD-change score could be found using bSLD (OR = 1.010, 95%CI = 0.999–1.021), or using NMO at baseline (OR = 1.608, 95%CI = 0.943–2.743). A bSLD cut-off value of 90 mm was found to be most distinctive for ETD. This cut-off value showed a significant difference for PFS (HR = 2.28, 95%CI = 1.12–4.64, p = 0.023) and OS (HR = 2.99, 95%CI = 1.41–6.34, p = 0.004). NMO also showed a difference for PFS and OS, however, not statistically significant.Conclusions: Tumor size and metastatic extent could not discriminate for tumor response, however, a bSLD of 90 mm could differentiate for PFS and OS.

AB - Background: Tumor size and metastatic extent may influence tumor response to immunotherapy in non-small cell lung cancer (NSCLC). The aim of this study was to examine the relationship between both baseline sum of longest diameters (bSLD) and number of metastatic organs (NMO) and the tumor response to pembrolizumab. Secondly, we aimed to analyze the association of baseline SLD and NMO with progression-free survival (PFS) and overall survival (OS).Methods: This retrospective study included patients with high PD-L1 expressing tumors (≥50%) and a good performance score (ECOG ≤ 2) that received first-line pembrolizumab monotherapy. Tumor response was calculated as the ‘SLD-change score’ and ‘early treatment discontinuation’ within 3 months on therapy (ETD). The relationship of both bSLD (based on RECIST v1.1) and NMO with tumor response and survival outcome (PFS, OS) was evaluated.Results: No significant differences in SLD-change score could be found using bSLD (OR = 1.010, 95%CI = 0.999–1.021), or using NMO at baseline (OR = 1.608, 95%CI = 0.943–2.743). A bSLD cut-off value of 90 mm was found to be most distinctive for ETD. This cut-off value showed a significant difference for PFS (HR = 2.28, 95%CI = 1.12–4.64, p = 0.023) and OS (HR = 2.99, 95%CI = 1.41–6.34, p = 0.004). NMO also showed a difference for PFS and OS, however, not statistically significant.Conclusions: Tumor size and metastatic extent could not discriminate for tumor response, however, a bSLD of 90 mm could differentiate for PFS and OS.

KW - Check point inhibitors

KW - Immunotherapy

KW - Non-small cell lung cancer

KW - PD-L1

KW - RECIST

KW - Tumor volume

UR - http://www.scopus.com/inward/record.url?scp=85117199225&partnerID=8YFLogxK

U2 - https://doi.org/10.1016/j.lungcan.2021.10.002

DO - https://doi.org/10.1016/j.lungcan.2021.10.002

M3 - Article

C2 - 34666276

SN - 0169-5002

VL - 162

SP - 36

EP - 41

JO - Lung Cancer

JF - Lung Cancer

ER -

The effect of tumor size and metastatic extent on the efficacy of first line pembrolizumab monotherapy in patients with high PD-L1 expressing advanced NSCLC tumors

Abstract

Keywords

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