TY - JOUR
T1 - Smoking status during first-line immunotherapy and chemotherapy in NSCLC patients: A case–control matched analysis from a large multicenter study.
AU - Cortellini, Alessio
AU - De Giglio, Andrea
AU - Cannita, Katia
AU - Cortinovis, Diego L.
AU - Cornelissen, Robin
AU - Baldesarri, Cinzia
AU - Giusti, Raffaele
AU - D'Argento, Ettore
AU - Grossi, Francesco
AU - Santoni, Matteo
AU - Catino, Annamaria
AU - Berardi, Rossana
AU - Sforza, Vincenzo
AU - Rossi, Giovanni
AU - Antonuzzo, Lorenzo
AU - Di Noia, Vincenzo
AU - Signorelli, Diego
AU - Gelibter, Alain
AU - Occhipinti, Mario Alberto
AU - Follador, Alessandro
AU - Rastelli, Francesca
AU - Chiari, Rita
AU - Gravara, Luigi Della
AU - Inno, Alessandro
AU - De Tursi, Michele
AU - Di Marino, Pietro
AU - Mansueto, Giovanni
AU - Zoratto, Federica
AU - Filetti, Marco
AU - Montrone, Michele
AU - Citarella, Fabrizio
AU - Pensieri, Maria Vittoria
AU - Russano, Marco
AU - Cantini, Luca
AU - Nigro, Olga
AU - Leonetti, Alessandro
AU - Bordi, Paola
AU - Minuti, Gabriele
AU - Landi, Lorenza
AU - De Toma, Alessandro
AU - Donisi, Clelia
AU - Ricciardi, Serena
AU - Migliorino, Maria Rita
AU - Napoli, Valerio Maria
AU - Leone, Gianmarco
AU - Metro, Giulio
AU - Banna, Giuseppe L.
AU - Friedlaender, Alex
AU - Addeo, Alfredo
AU - Ficorella, Corrado
AU - Porzio, Giampiero
N1 - Publisher Copyright:
© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - Background: Improved outcome in tobacco smoking patients with non-small cell lung cancer (NSCLC) following immunotherapy has previously been reported. However, little is known regarding this association during first-line immunotherapy in patients with high PD-L1 expression. In this study we compared clinical outcomes according to the smoking status of two large multicenter cohorts. Methods: We compared clinical outcomes according to the smoking status (never smokers vs. current/former smokers) of two retrospective multicenter cohorts of metastatic NSCLC patients, treated with first-line pembrolizumab and platinum-based chemotherapy. Results: A total of 962 NSCLC patients with PD-L1 expression ≥50% who received first-line pembrolizumab and 462 NSCLC patients who received first-line platinum-based chemotherapy were included in the study. Never smokers were confirmed to have a significantly higher risk of disease progression (hazard ratio [HR] = 1.49 [95% CI: 1.15–1.92], p = 0.0022) and death (HR = 1.38 [95% CI: 1.02–1.87], p = 0.0348) within the pembrolizumab cohort. On the contrary, a nonsignificant trend towards a reduced risk of disease progression (HR = 0.74 [95% CI: 0.52–1.05], p = 0.1003) and death (HR = 0.67 [95% CI: 0.45–1.01], p = 0.0593) were reported for never smokers within the chemotherapy cohort. After a random case–control matching, 424 patients from both cohorts were paired. Within the matched pembrolizumab cohort, never smokers had a significantly shorter progression-free survival (PFS) (HR = 1.68 [95% CI: 1.17–2.40], p = 0.0045) and a nonsignificant trend towards a shortened overall survival (OS) (HR = 1.32 [95% CI: 0.84–2.07], p = 0.2205). On the contrary, never smokers had a significantly longer PFS (HR = 0.68 [95% CI: 0.49–0.95], p = 0.0255) and OS (HR = 0.66 [95% CI: 0.45–0.97], p = 0,0356) compared to current/former smoker patients within the matched chemotherapy cohort. On pooled multivariable analysis, the interaction term between smoking status and treatment modality was concordantly statistically significant with respect to ORR (p = 0.0074), PFS (p = 0.0001) and OS (p = 0.0020), confirming the significantly different impact of smoking status across the two cohorts. Conclusions: Among metastatic NSCLC patients with PD-L1 expression ≥50% receiving first-line pembrolizumab, current/former smokers experienced improved PFS and OS. On the contrary, worse outcomes were reported among current/former smokers receiving first-line chemotherapy.
AB - Background: Improved outcome in tobacco smoking patients with non-small cell lung cancer (NSCLC) following immunotherapy has previously been reported. However, little is known regarding this association during first-line immunotherapy in patients with high PD-L1 expression. In this study we compared clinical outcomes according to the smoking status of two large multicenter cohorts. Methods: We compared clinical outcomes according to the smoking status (never smokers vs. current/former smokers) of two retrospective multicenter cohorts of metastatic NSCLC patients, treated with first-line pembrolizumab and platinum-based chemotherapy. Results: A total of 962 NSCLC patients with PD-L1 expression ≥50% who received first-line pembrolizumab and 462 NSCLC patients who received first-line platinum-based chemotherapy were included in the study. Never smokers were confirmed to have a significantly higher risk of disease progression (hazard ratio [HR] = 1.49 [95% CI: 1.15–1.92], p = 0.0022) and death (HR = 1.38 [95% CI: 1.02–1.87], p = 0.0348) within the pembrolizumab cohort. On the contrary, a nonsignificant trend towards a reduced risk of disease progression (HR = 0.74 [95% CI: 0.52–1.05], p = 0.1003) and death (HR = 0.67 [95% CI: 0.45–1.01], p = 0.0593) were reported for never smokers within the chemotherapy cohort. After a random case–control matching, 424 patients from both cohorts were paired. Within the matched pembrolizumab cohort, never smokers had a significantly shorter progression-free survival (PFS) (HR = 1.68 [95% CI: 1.17–2.40], p = 0.0045) and a nonsignificant trend towards a shortened overall survival (OS) (HR = 1.32 [95% CI: 0.84–2.07], p = 0.2205). On the contrary, never smokers had a significantly longer PFS (HR = 0.68 [95% CI: 0.49–0.95], p = 0.0255) and OS (HR = 0.66 [95% CI: 0.45–0.97], p = 0,0356) compared to current/former smoker patients within the matched chemotherapy cohort. On pooled multivariable analysis, the interaction term between smoking status and treatment modality was concordantly statistically significant with respect to ORR (p = 0.0074), PFS (p = 0.0001) and OS (p = 0.0020), confirming the significantly different impact of smoking status across the two cohorts. Conclusions: Among metastatic NSCLC patients with PD-L1 expression ≥50% receiving first-line pembrolizumab, current/former smokers experienced improved PFS and OS. On the contrary, worse outcomes were reported among current/former smokers receiving first-line chemotherapy.
KW - immunotherapy
KW - non-small cell lung cancer
KW - pembrolizumab
KW - smoking
KW - tobacco
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U2 - 10.1111/1759-7714.13852
DO - 10.1111/1759-7714.13852
M3 - Article
AN - SCOPUS:85100080636
VL - 12
SP - 880
EP - 889
JO - Thoracic Cancer
JF - Thoracic Cancer
SN - 1759-7706
IS - 6
ER -