What type of study is this?

December 4, 2025Therapeutic Advances in Medical Oncology0 citationsOpen Access

Pembrolizumab versus pembrolizumab plus chemotherapy in patients with PDL1 ⩾50% advanced non-small-cell lung cancer, depending on tumor aggressiveness and clinical impact

MLMarine Lejeune EWEric Wasielewski VLVincent Leroy

Key Points

Overall survival improved with pembrolizumab alone compared to pembrolizumab plus chemotherapy in advanced non-small-cell lung cancer.
Patients receiving pembrolizumab experienced a better restricted mean survival time than those receiving chemotherapy combination.
Observational analysis using a multicenter retrospective study highlights the significance of treatment strategies based on tumor aggressiveness.
Chemotherapy-related toxicities negatively impact survival, emphasizing the importance of treatment selection in advanced cancer cases.

Abstract

Background: Pembrolizumab plus chemotherapy (Pembrolizumab-CT) has been suggested as first-line treatment over pembrolizumab alone in aggressive non-small-cell lung cancer (NSCLC) with ⩾50% PDL1, but studies comparing these two strategies are lacking. Objectives: To compare overall survival under pembrolizumab and Pembrolizumab-CT depending on tumor aggressiveness in PDL1 ⩾50% advanced NSCLC patients. Design: A multicenter retrospective study was conducted of all patients with advanced NSCLC, PDL1 ⩾50% and ECOG 0–1, who received pembrolizumab or Pembrolizumab-CT as first-line treatment. Methods: Tumor aggressiveness was defined as a sum of longest diameters (SLD) ⩾ 100 mm, a largest lesion diameter (LLD) >60 mm, ECOG 1, or need for corticosteroid therapy. Overall survival was analyzed in the whole population and in subgroups as restricted mean survival time (RMST) adjusted for the main prognostic variables. Results: Ninety-six of the 164 included patients (58.5%) received pembrolizumab, and 68 (41.5%) received Pembrolizumab-CT. In the study group overall, the RMST was significantly shorter under Pembrolizumab-CT than under pembrolizumab (−7.9 months; p = 0.03). RMSTs were significantly shorter in the Pembrolizumab-CT group among patients with LLD <60 mm (−8.6 months, p = 0.04) and among ECOG-0 patients (−12.3 months, p < 0.001). RMSTs did not differ significantly between groups in patients with SLD ⩾ 100 mm (−1.1 months; p = 0.82), in patients with SLD <100 mm (−3.1 months, p = 0.54), in patients with LLD ⩾ 60 mm (0.9 months; p = 0.75), in patients with need for corticosteroid therapy (−2.9 months, p = 0.62), or in ECOG-1 patients (−6.1 months, p = 0.12). Toxicity-related hospitalizations appeared more frequent under Pembrolizumab-CT (20.5%) than under pembrolizumab (12.5%). Conclusion: Pembrolizumab-CT was not associated with improved survival compared with pembrolizumab alone, in PDL1 ⩾ 50% advanced NSCLC patients, even in cases of aggressive disease. Chemotherapy-related toxicities may have had a negative effect on survival.

Ask AI

Helpful

Bookmark

View Full Paper