Efficacy of Immune Checkpoint Inhibitor With or Without Chemotherapy for Nonsquamous NSCLC With Malignant Pleural Effusion: A Retrospective Multicenter Cohort Study

Hayato Kawachi, MD; Motohiro Tamiya, MD; Yoshihiko Taniguchi, MD; Toshihide Yokoyama, MD; Shinya Yokoe, MD; Yuko Oya, MD, PhD; Mihoko Imaji, MD; Fukuko Okabe, MD; Masaki Kanazu, MD; Yoshihiko Sakata, MD; Shinya Uematsu, MD; Satoshi Tanaka, MD; Daisuke Arai, MD, PhD; Go Saito, MD; Hiroshi Kobe, MD; Eisaku Miyauchi, MD, PhD; Asuka Okada, MD, PhD; Satoshi Hara, MD; Toru Kumagai, MD, PhD

JTO Clinical and Research Reports (Jul 2022)

Efficacy of Immune Checkpoint Inhibitor With or Without Chemotherapy for Nonsquamous NSCLC With Malignant Pleural Effusion: A Retrospective Multicenter Cohort Study

Hayato Kawachi, MD,
Motohiro Tamiya, MD,
Yoshihiko Taniguchi, MD,
Toshihide Yokoyama, MD,
Shinya Yokoe, MD,
Yuko Oya, MD, PhD,
Mihoko Imaji, MD,
Fukuko Okabe, MD,
Masaki Kanazu, MD,
Yoshihiko Sakata, MD,
Shinya Uematsu, MD,
Satoshi Tanaka, MD,
Daisuke Arai, MD, PhD,
Go Saito, MD,
Hiroshi Kobe, MD,
Eisaku Miyauchi, MD, PhD,
Asuka Okada, MD, PhD,
Satoshi Hara, MD,
Toru Kumagai, MD, PhD

Affiliations

Hayato Kawachi, MD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan; Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan; Corresponding author. Address for correspondence: Hayato Kawachi, MD, Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Osaka 541-8567, Japan.
Motohiro Tamiya, MD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan
Yoshihiko Taniguchi, MD: Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
Toshihide Yokoyama, MD: Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
Shinya Yokoe, MD: Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
Yuko Oya, MD, PhD: Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
Mihoko Imaji, MD: Internal Medicine III, Wakayama Medical University, Wakayama, Wakayama, Japan
Fukuko Okabe, MD: Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
Masaki Kanazu, MD: Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
Yoshihiko Sakata, MD: Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, Japan
Shinya Uematsu, MD: Department of Respiratory Medicine, Osaka Red Cross Hospital, Osaka, Osaka, Japan
Satoshi Tanaka, MD: Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Osaka, Japan
Daisuke Arai, MD, PhD: Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
Go Saito, MD: Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
Hiroshi Kobe, MD: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
Eisaku Miyauchi, MD, PhD: Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
Asuka Okada, MD, PhD: Department of Respiratory Medicine, Saiseikai Suita Hospital, Suita, Osaka, Japan
Satoshi Hara, MD: Department of Respiratory Medicine, Itami City Hospital, Itami, Japan
Toru Kumagai, MD, PhD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan

Journal volume & issue: Vol. 3, no. 7
p. 100355

Abstract

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Introduction: Malignant pleural effusion (MPE) is associated with poor treatment outcome in patients with NSCLC receiving immune checkpoint inhibitors (ICIs). ICIs and chemotherapy (ICI/Chemo) combination therapy is currently the standard therapy for NSCLC, and some ICI/Chemo regimens for nonsquamous (non-Sq) NSCLC contain bevacizumab (BEV), which is effective for controlling MPE and may enhance immune response. This study aimed to determine the optimal first-line treatment for this clinical population. Methods: We retrospectively enrolled consecutive patients with non-Sq NSCLC with MPE who received ICI/Chemo or pembrolizumab monotherapy. Treatment outcomes were analyzed in patients with programmed death-ligand 1 (PD-L1) tumor proportion score more than or equal to 50% who were administered ICI/Chemo or pembrolizumab monotherapy (PD-L1 high cohort) and in patients with any PD-L1 status, treated with ICI/Chemo with or without BEV (ICI/Chemo cohort). We used propensity score matching (PSM) to reduce bias. Results: PD-L1 high and ICI/Chemo cohorts included 143 and 139 patients, respectively. In PD-L1 high cohort, 37 patients received ICI/Chemo. With PSM, the median progression-free survival was significantly longer in the ICI/Chemo group than in the pembrolizumab group (11.1 versus 3.9 mo, respectively, p = 0.0409). In the ICI/Chemo cohort, 23 patients received BEV. With PSM, no significant difference occurred in median progression-free survival between BEV and non-BEV groups (6.1 versus 7.4 mo, p = 0.9610). Conclusion: ICI/Chemo seemed more effective than pembrolizumab monotherapy for patients with non-Sq NSCLC with MPE. Nevertheless, the synergistic effect of BEV with ICI/Chemo may be limited. Further studies are needed to clarify the key factor in the tumor-induced immunosuppression environment in these patients.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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