Real-world evidence for pembrolizumab in non-small cell lung cancer: a nationwide cohort study

Helga H Hektoen; Kaitlyn M Tsuruda; Lars Fjellbirkeland; Yngvar Nilssen; Odd Terje Brustugun; Bettina K Andreassen

doi:10.1038/s41416-024-02895-1

Real-world evidence for pembrolizumab in non-small cell lung cancer: a nationwide cohort study

Br J Cancer. 2024 Nov 3. doi: 10.1038/s41416-024-02895-1. Online ahead of print.

Authors

Helga H Hektoen^{1

2}, Kaitlyn M Tsuruda¹, Lars Fjellbirkeland^{3

4}, Yngvar Nilssen⁵, Odd Terje Brustugun^{4

6}, Bettina K Andreassen⁷

Affiliations

¹ Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway.
² Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
³ Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway.
⁴ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Registration, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway.
⁶ Section of Oncology, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway.
⁷ Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway. [email protected].

PMID: 39489879
DOI: 10.1038/s41416-024-02895-1

Abstract

Background: Based on favourable results from clinical trials, immune checkpoint inhibitors (ICI) have become the standard first line (1 L) systemic anticancer treatment (SACT) for advanced stage non-small cell lung cancer (NSCLC) without targetable mutations. We evaluate whether these results are generalizable to everyday clinical practice and compare overall survival (OS) of patients treated with ICI to a historical cohort of patients treated with chemotherapy and results from clinical trials.

Methods: Our study comprised all advanced NSCLC patients initiating SACT in 2012-21 in Norway. Clinical characteristics and treatment information was retrieved from Norwegian Health Registries.

Results: Survival for all 8416 advanced NSCLC patients treated with SACT increased concurrently with the gradual implementation of ICIs. Median OS of patients treated with 1 L pembrolizumab after 2017 was better (mono-/combination therapy: 13.8/12.8 months) than for patients treated with chemotherapy before 2017 (8.0 months). Although median OS for patients treated with pembrolizumab was lower in clinical practice than clinical trials (Keynote-024/189: 26.3/22.0 months), the survival benefit relative to chemotherapy was similar.

Conclusion: Our nationwide study demonstrated a survival benefit over conventional chemotherapy of a similar magnitude as observed in clinical trials and confirms the effectiveness of pembrolizumab in routine clinical practice.