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Modified-Dose Pembrolizumab and Prognostic Outcomes among Non-Small Cell Lung Cancer Patients: A Chart Review Study

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  • Sheng-Yin To

    (Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 11490, Taiwan
    School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan)

  • Li-Ting Kao

    (Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 11490, Taiwan
    School of Pharmacy, National Defense Medical Center, Taipei 11490, Taiwan
    Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan)

  • Jui-Hu Shih

    (Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 11490, Taiwan
    School of Pharmacy, National Defense Medical Center, Taipei 11490, Taiwan)

  • I-Hsun Li

    (Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 11490, Taiwan
    School of Pharmacy, National Defense Medical Center, Taipei 11490, Taiwan
    Department of Pharmacology, National Defense Medical Center, Taipei 11490, Taiwan)

  • Tsai-Wang Huang

    (Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan)

  • Chen-Liang Tsai

    (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan)

  • Chih-Feng Chian

    (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan)

  • Ching-Liang Ho

    (Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan)

  • Ping-Ying Chang

    (Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan)

Abstract

The modified dose (MD) regimen of pembrolizumab (2 mg/kg or 100 mg every 3 weeks) is an alternative option to reduce the financial burden resulting from the extremely high cost of the standard dose (SD) regimen (200 mg every 3 weeks). However, the clinical effectiveness and prognostic outcomes have not been fully elucidated in real-word clinical practice. Sixty-four consecutive patients in Taiwan receiving pembrolizumab for advanced NSCLC between 2018 and 2020 were recruited in this study. Comparisons of overall survival (OS) and progression-free survival (PFS) were performed using Kaplan–Meier survival curves. Additionally, 12 predictors, including pembrolizumab regimen, dose, neutrophil-to-lymphocyte ratio (NLR), age, sex, histopathology, smoking history, ECOG PS, EGFR mutation, PD-L1 expression, distant metastases and treatment line, were analyzed in multivariable Cox models for predicting OS and PFS. The results showed that the MD group and the SD group had similar OS and PFS, especially in patients beyond first-line treatment or with a pretreatment NLR < 5. The NLR was the only independent factor associated with both OS (adjusted HR = 0.052; p = 0.010) and PFS (adjusted HR = 0.259; p = 0.021). The results of this study assure the clinical effectiveness of MD pembrolizumab and suggest that the pretreatment NLR could highlight patients who may benefit from MD pembrolizumab.

Suggested Citation

  • Sheng-Yin To & Li-Ting Kao & Jui-Hu Shih & I-Hsun Li & Tsai-Wang Huang & Chen-Liang Tsai & Chih-Feng Chian & Ching-Liang Ho & Ping-Ying Chang, 2022. "Modified-Dose Pembrolizumab and Prognostic Outcomes among Non-Small Cell Lung Cancer Patients: A Chart Review Study," IJERPH, MDPI, vol. 19(10), pages 1-13, May.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:10:p:5999-:d:815950
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    References listed on IDEAS

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    1. Alberto Mantovani & Paola Allavena & Antonio Sica & Frances Balkwill, 2008. "Cancer-related inflammation," Nature, Nature, vol. 454(7203), pages 436-444, July.
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