(131) Routine Clinical Use of PD-1/PD-L1 Immune Checkpoint Inhibitors and Survival in Patients With Advanced Cancers: A Danish Population-Based Cohort Study

Publication Number: 792

Background: PD-1/PD-L1 immune checkpoint inhibitors were first approved in the metastatic setting in 2014 for non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC) and in 2016 for urothelial carcinoma (UC). More data are needed on the use of these drugs in routine clinical care for patients with advanced cancers.

Objectives: We aimed to describe the proportion of patients with advanced NSCLC, RCC, or UC who received PD-1/PD-L1 inhibitors and median overall survival by type of first-line treatment.

Methods: Using nationwide Danish medical registries, we assembled cohorts of Danish patients diagnosed with stage III or IV NSCLC, stage II, III, or IV UC, or stage III or IV RCC between Jan 1, 2013, and Dec 31, 2020, who were followed up until death, emigration, new primary cancer, or end of follow-up (Jun 30, 2022). Here, we describe the percentage of patients treated with PD-1/PD-L1 inhibitor containing regimens at any line of treatment. Furthermore, overall survival since initiation of first-line PD-1/PD-L1 inhibitor monotherapy, and the most common other systemic anticancer therapy was determined using Kaplan–Meier methods.

Results: Of 19,350 patients with advanced NSCLC, 2,951 (15.3%) received PD-1/PD-L1 inhibitors. The median overall survival since treatment initiation was 17.0 months (95% CI, 15.4-18.6) in the 1,037 patients who received PD-1/PD-L1 inhibitors as first-line monotherapy vs 11.1 months (95% CI, 10.7-11.4) in the 9,096 patients who received first-line chemotherapy alone. Of 3,970 patients with advanced UC, 358 (9.0%) received PD-1/PD-L1 inhibitors. The median overall survival was 13.8 months (95% CI, 10.3-17.3) in the 90 patients who received PD-1/PD-L1 inhibitors as first-line monotherapy vs 21.9 months (95% CI, 19.8-24.4) in the 1,548 patients who received first-line chemotherapy. Of 2,009 patients with advanced RCC, 422 (21.0%) received PD-1/PD-L1 inhibitors. The median overall survival was 57.8 months (95% CI, 25.5-not estimable) in the 53 patients who received PD-1/PD-L1 inhibitors as first-line monotherapy vs 14.4 months (95% CI, 12.5-16.2) in the 693 patients who received tyrosine kinase inhibitors as first-line monotherapy.

Conclusions: Overall survival after initiation of first-line treatment was longer in those receiving PD-1/PD-L1 inhibitors as first-line monotherapy compared with the most common systemic anticancer therapies in patients with NSCLC or RCC but was shorter in patients with UC. These descriptive results show outcomes with routine clinical use of these treatments but do not account for patient clinical characteristics or performance status, which might confound the association between treatments and survival.