Efficacy and safety of PD-1/PD-L1 inhibitors plus nab-paclitaxel for patients with non-small cell lung cancer who have progressed after platinum-based chemotherapy

Fan Zhang; Di Huang; Lei Zhao; Tao Li; Sujie Zhang; Guoqing Zhang; Fang Yuan; Jie Zhang; Yuzi Zhang; Zhengyi Zhao; Longgang Cui; Jing Zhao; Guoqiang Wang; Shangli Cai; Yuezong Bai; Jinliang Wang; Yi Hu

doi:10.1177/1758835920936882

Efficacy and safety of PD-1/PD-L1 inhibitors plus nab-paclitaxel for patients with non-small cell lung cancer who have progressed after platinum-based chemotherapy

Ther Adv Med Oncol. 2020 Jul 6:12:1758835920936882. doi: 10.1177/1758835920936882. eCollection 2020.

Authors

Fan Zhang¹, Di Huang², Lei Zhao³, Tao Li¹, Sujie Zhang¹, Guoqing Zhang¹, Fang Yuan¹, Jie Zhang⁴, Yuzi Zhang⁵, Zhengyi Zhao⁵, Longgang Cui⁵, Jing Zhao⁵, Guoqiang Wang⁵, Shangli Cai⁵, Yuezong Bai⁵, Jinliang Wang⁶, Yi Hu⁷

Affiliations

¹ Department of Oncology, Chinese PLA General Hospital, PLA School of Medicine, Beijing, People's Republic of China.
² School of Medicine, Nankai University, Tianjin, People's Republic of China.
³ Translational Medicine Center, National Clinical Research Center for Normal Aging and Geriatric & The Key Lab of Normal Aging and Geriatric, Institute of Geriatric, PLA General Hospital, Beijing, People's Republic of China.
⁴ Nursing Department, Chinese PLA General Hospital, PLA School of Medicine, Beijing, People's Republic of China.
⁵ The Medical Department, 3D Medicines Inc., Shanghai, People's Republic of China.
⁶ Department of Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing 100853, P.R. China.
⁷ Department of Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing 100853, People's Republic of China.

Abstract

Background: Immunotherapy combined with platinum-based chemotherapy is now the standard first-line treatment for non-small cell lung cancer (NSCLC) patients. However, limited evidence exists to show the efficacy of immunotherapy plus taxanes for patients who have progressed after platinum-based chemotherapy.

Methods: The immunotherapy naïve patients with metastatic NSCLC who received anti-PD-1/PD-L1 monotherapy or combined with nab-paclitaxel after prior platinum-based chemotherapy from 2015 to 2018 in PLA General Hospital were identified. The progression-free survival, overall survival (OS), objective response rate (ORR), disease control rate (DCR) and safety were assessed.

Results: Of 57 patients, 40 were treated with anti-PD-1/PD-L1 monotherapy and 17 were treated with anti-PD-1/PD-L1 plus nab-paclitaxel. With a median OS follow-up of 16.3 months, the nab-paclitaxel group showed significantly longer OS compared with the immune monotherapy group (median, 28.6 months versus 15.9 months, log-rank p = 0.020). When adjusted by covariates in COX proportional regression model, both the treatment group [p = 0.009, hazard ratio (HR) 0.361; 95% confidence interval (CI) 0.168-0.773] and performance status (p = 0.003, HR 0.372; 95% CI 0.192-0.721) demonstrated independent association with the longer OS from combination therapy. In addition, ORR was 23.5% (4/17) in the immune checkpoints inhibitors (ICIs) plus nab-paclitaxel group versus 13.5% (5/37) in immune monotherapy group (p = 0.439), with a DCR of 88.2% (15/17) and 59.5% (22/37) (p = 0.034), respectively. The incidence of grade 3/4 adverse events was 23.5% (4/17) in the combination group and 2.5% (1/40) in the immune monotherapy group.

Conclusion: PD-1/PD-L1 inhibitor plus nab-paclitaxel resulted in significantly longer OS and higher response versus ICI single agent in metastatic NSCLC patients who have progressed after platinum-based chemotherapy. These findings need to be further explored by prospective studies.

Keywords: immune checkpoint inhibitor; nab-paclitaxel; non-small cell lung cancer.