Immunotoxicity of Pembrolizumab in patients with metastatic non-small cell lung cancer: A single-centre study

  • Miloš Stojanović Doctor of medicine
  • Daliborka Bursać
Keywords: NSCLC; First line treatment; Immunotherapy; Pembrolizumab; irAEs

Abstract


Background: Immunotherapy represents a new form of treatment, that stimulates immune system to destroy cancer cells. Pembrolizumab is a humanized monoclonal antibody that binds to the PD-1 programmed cell death receptor and blocks its interaction with the PD-L1 and PD-L2 ligands. The aim of this study was to determine the efficacy and safety of the drug pembrolizumab, in the first line of treatment in patients with metastatic NSCLC. Methods: The research was retrospective and was conducted at the Institute for Pulmonary Diseases of Vojvodina, it included patients treated in the period from January 2018 to December 2019, in whom metastatic NSCLC was verified. Results: The study included a total of 20 patients, 10 men and 10 women. The average age was 61.75 years. The average length of therapy was 15 cycles (45 weeks), the minimum was 1, and the maximum was 33. 12 patients (60%) had a lethal outcome. The median time to disease progression was 8.1 months and overall survival was 14.6 months. Of the total number of patients, 13 (65%) had side effects to pembrolizumab therapy, and 7 (35%) did not experience any. Out of a total of 13 patients who had side effects, 9 had only one isolated, 4 had more associated side effects, of which 3 patients had 2 associated, and 1 patient had 3 associated side effects. Conclusion: Based on the results, immunotherapy certainly occupies an important place in the treatment of metastatic NSCLC. Namely, the lack of severe side effects linked to cytotoxic chemotherapy and the relative ease of treating immune related adverse effects (irAEs) that occur with immunotherapy, good overall survival and later onset of disease progression opens the door to the possibility of a better quality of life for these patients and the prolongation of their lifespan.

References

Data source: GLOBOCAN 2022; Available at Global Cancer Observatory (https://gco.iarc.fr/) International Agency for Research on Cancer 2022.

Rodak O, Peris-Diaz MD, Olbromski M, Podhorska-Okolow M, Dziegiel P. Current Landscape of Non-Small Cell Lung Cancer: Epidemiology, Histological Classification, Targeted Therapies, and Immunotherapy. Cancers. 2021;13(18),4705.

Meza R, Meernik C, Jeon J, Cote ML. Lung cancer incidence trends by gender, race and histology in the United States, 1973-2010. PLoS ONE. 2015;10,e0121323.

Camidge DR, Doebele RC, Kerr KM. Comparing and contrasting predictive biomarkers for immunotherapy and targeted therapy of NSCLC. Nat Rev Clin Oncol. 2019;16,341–355.

Beatty GL, Gladney WL. Immune escape mechanisms as a guide for cancer immunotherapy. Clin Cancer Res. 2015;21,687–692.

Rossi A. Immunotherapy and NSCLC: The long and winding road. Cancers. 2020;12(9),2512.

Wang S, Khan IF. Investigation of Molecular Interactions Mechanism of Pembrolizumab and PD-1. Int J Mol Sci. 2023;24(13),10684.

Dang TO, Ogunniyi A, Barbee MS, and Drilon A. Pembrolizumab for the treatment of PD-L1 positive advanced or metastatic non-small cell lung cancer. Expert Rev Anticancer Ther. 2016;16(1):13-20.

Bai R, Lv Z, Xu D, Cui J. Predictive biomarkers for cancer immunotherapy with immune checkpoint inhibitors. Biomark Res. 2020;8,1–17.

Shen K, Cui J, Wei Y, Chen X, Liu G, Gao X et al. Effectiveness and safety of PD-1/PD-L1 or CTLA4 inhibitors combined with chemotherapy as a first-line treatment for lung cancer: A meta-analysis. J Thorac Dis. 2018;10,6636–6652.

Ahn MJ, Sun JM, Lee SH, Ahn JS, Park K. EGFR TKI combination with immunotherapy in non-small cell lung cancer. Expert Opin.Drug Saf. 2017;16,465–469.

Reck M. Pembrolizumab as first-line therapy for metastatic non-small cell lung cancer. Immunotherapy. 2018;10(2):93-105.

Reck M, Rodríguez AD, Robinson GA, Hui R, Csöszi T, Fulop A et al. Updated Analysis of KEYNOTE-024: Pembrolizumab Versus Platinum-Based Chemotherapy for Advanced Non-Small-Cell Lung Cancer With PD-L1 Tumor Proportion Score of 50% or Greater. J Clin Oncol. 2019; Mar 1;37(7):537-546.

Schneider JB, Naidoo J, Santomasso DB, Lacchetti C, Adkins S, Anadkat M et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J Clin Oncol. 2022 Jan 20;40(3):315.

Published
2024/08/13
Section
Original Scientific Paper