Certain patients may derive more benefit from immunotherapy for non-small cell lung cancer
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Men, smokers and younger patients with non-small cell lung cancer all appeared to derive more benefit from immunotherapy, according to a systematic review published in JNCI Cancer Spectrum.
Although researchers reported mixed evidence overall, they recommended that physicians be mindful of personal characteristics when formulating treatment plans.
“Right now, there is no algorithm that predicts who will respond well to this novel treatment. Our work contributes to identifying important elements of such an algorithm,” Emanuela Taioli, MD, PhD, associate director for population science at Tisch Cancer Institute, director of the Institute for Translational Epidemiology and professor of population health science and policy and thoracic surgery at Icahn School of Medicine at Mount Sinai, told Healio.
Background and methodology
Immunotherapy is the standard of care for many of the approximately 200,000 patients treated annually for NSCLC in the United States; however, many patients do not benefit, Taioli and colleagues wrote.
“It is constantly reported in clinical practice that only a fraction of patients treated with immunotherapy respond to it. We hypothesized that personal and clinical characteristics were partially responsible for this poor response observed in a subset of patients,” Taioli said.
The analysis included 18 randomized controlled trials that included 6,534 patients who received immunotherapy and 11,192 who did not, and 16 observational studies that included 9,073 patients who received immunotherapy.
Researchers utilized Web of Science, Ovid EMBASE and MEDLINE records from 2013 to January 2021 to gather information on all studies reporting OS and PFS for patients treated with immunotherapy for stage IIIB or greater NSCLC.
Key findings
Among randomized controlled trials, researchers observed improved survival with the addition of immunotherapy in patients aged younger than 65 years in 10 of 17 studies, smokers in eight of 15 studies, and males in 10 of 17 vs. females in six of 17 studies.
In observational studies, researchers reported younger patients (aged < 60, < 65 or < 70 years in most studies) had longer survival than older patients (aged 60, 65 or 70 years) in four of 13 studies, ever-smokers in seven of 13 studies, and females in two of 14 studies. Three studies that reported race showed mixed results.
Implications
Taioli told Healio she was surprised at the lack of epidemiologic studies on patients treated with immunotherapy, noting most of the studies reviewed were clinical trials or clinical series of patients.
“We need to conduct a large, population-based observational study of patients treated with immunotherapy, with no restrictions on age or comorbidities, and incorporate tumor markers,” Taioli said. “This study would generate important information on how to use immunotherapy going forward.”
For more information:
Emanuela Taioli, MD, PhD, can be reached at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY 10029; email: emanuela.taioli@mountsinai.org.
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