WCLC 2025 - Posters & ePosters-EP.17.29 Real-World Effectiveness of Immunotherapy for Advanced Non-Small Cell Lung Cancer (NSCLC) Without Oncogenic Driver Alteration

EP.17.29 Real-World Effectiveness of Immunotherapy for Advanced Non-Small Cell Lung Cancer (NSCLC) Without Oncogenic Driver Alteration

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This retrospective cohort study evaluated the real-world effectiveness of immune checkpoint inhibitors (ICIs) versus chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) lacking oncogenic driver mutations, treated at Siriraj Hospital, Bangkok, from 2016 to 2023. The study compared outcomes among three groups: first-line ICIs (1L-ICIs), first-line chemotherapy followed by second-line ICIs (2L-ICIs), and chemotherapy alone (CMT alone).<br /><br />Key baseline characteristics showed similar distributions of sex, histology, and brain metastasis, but differences in age, ECOG performance status, and PD-L1 expression among groups. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier and Cox proportional hazard models.<br /><br />Results demonstrated that 1L-ICIs significantly improved PFS (median 24.6 months; HR 0.35, p=0.001) and OS (median 27.1 months; HR 0.70, p=0.027) compared with chemotherapy alone, which had median PFS and OS of 8.9 and 19.4 months, respectively. Administration of 2L-ICIs also significantly improved OS (median 28.7 months; HR 0.60, p=0.001) compared to chemotherapy alone but did not show significant PFS benefit. Importantly, OS did not significantly differ between patients receiving ICIs as first-line versus second-line therapy (HR 1.15; p=0.45).<br /><br />The study concludes that ICIs, whether given as first-line or second-line treatment, significantly enhance survival outcomes in advanced NSCLC patients without oncogenic drivers relative to chemotherapy alone. These findings support the real-world benefit of immunotherapy in this population.<br /><br />Future research directions include validating these results in larger cohorts, conducting subgroup and multivariable analyses to adjust for confounding factors, and performing cost-utility analyses to inform reimbursement policy decisions regarding ICI use in first- and second-line settings.

Asset Subtitle

Chulamas Horugsa

Meta Tag

Speaker Chulamas Horugsa

Topic Global Health, Health Services, and Health Economics

Keywords

immune checkpoint inhibitors

non-small cell lung cancer

advanced NSCLC

first-line therapy

second-line therapy

chemotherapy

progression-free survival

overall survival

PD-L1 expression

real-world study