Efficacy of Pembrolizumab vs. Nivolumab Plus Ipilimumab in Metastatic NSCLC in Relation to PD-L1 and TMB Status

Walid Shalata, Natalie Maimon Rabinovich, Abed Agbarya, Alexander Yakobson, Yulia Dudnik, Ashraf Abu Jama, Ahron Yehonatan Cohen, Sondos Shalata, Ahmad Abu Hamed, Tahel Ilan Ber, Oshri Machluf, Gal Shoham Levin, Amichay Meirovitz

    Research output: Contribution to journalArticlepeer-review

    Abstract

    The efficacy of immune checkpoint inhibitor (ICI) therapy concerning programmed death ligand 1 (PD-L1) status is well established in patients diagnosed with non-small cell lung cancer (NSCLC). However, there remains a paucity of evidence regarding the efficacy concerning tumor mutational burden (TMB) in both clinical trials and real-world data (RWD). In the current article, clinicopathological and molecular epidemiological data were meticulously collected, and treatment modalities were meticulously recorded. The final analysis included a study population of 194 patients. Median age was 67 years (range 37–86), with the majority being male (71.13%), and 85.71% of patients were either current or former smokers at diagnosis. Adenocarcinoma accounted for most diagnoses (71.65%), followed by squamous cell carcinoma (24.23%). In terms of PD-L1 status, 42.78% had an expression level below 1%, 28.35% had an expression between 1–49%, and 28.87% had an expression above 50%. The TMB ranged from 0 to 75, with a median of 10.31 (range 0–75) for PD-L1 expression below 1%, with a median of 9.73 (range 0.95–39.63) for PD-L1 expression between 1–49%, and a median of 9.72 (range 0.95–48) for PD-L1 expression above 50%. Corresponding to patients with low PDL-1 less than 1% and low TMB (0–5), the median overall survival (mOS) was 16 (p = 0.18), and 15 months (p = 0.22), patients with medium PDL-1 (1–49%) and medium TMB (5–10), the mOS was 15 (p = 0.18) and 16 months (p = 0.22), patients with high PDL-1 (>50) and high TMB (>10), the mOS was 24 (p = 0.18) and 21 (p = 0.22) months. This study represents the largest academic RWD dataset concerning PD-L1 and TMB status in patients with locally advanced and metastatic NSCLC.

    Original languageEnglish
    Article number1825
    JournalCancers
    Volume16
    Issue number10
    DOIs
    StatePublished - 1 May 2024

    Keywords

    • PDL-1
    • TMB
    • immune checkpoint inhibitor
    • ipilimumab
    • nivolumab
    • non-small cell lung cancer (NSCLC)
    • pembrolizumab
    • real-world data

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

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