Efectividad y seguridad en la práctica clínica de anticuerpos anti PD-1/PD-L1 en monoterapia en el cáncer de pulmón no microcítico

Objective: To evaluate the efficacy and safety of anti-PD-1 and anti-PD-L1 immunotherapy agents as monotherapy in patients with non-small cell  lung cancer. Method: This was a four-year retrospective observational study that included all patients with non-small cell lung cancer treated with  nivolumab, pembrolizumab, and atezolizumab in a third level hospital. Demographic, clinical (ECOG status, stage, PD-L1 expression  level), therapeutic (drug, start date, line of treatment and number of  cycles), efficacy (date and status at the end of follow-up) and toxicity  variables were collected. Data was extracted from the patient’s electronic  medical record. Overall survival and progression-free survival rates for  different monitoring times were calculated. Results: The study included 80 patients, 35 on nivolumab, 32 on  pembrolizumab and 13 on atezolizumab. The median overall survival was  not achieved. Overall survival at 6, 12, 18 and 49 months in patients  treated with nivolumab was 79.7%, 74.0%, 65.8% and 65.8%,  respectively. Median progression-free survival was 15 months. Adverse  events were observed in 85.7% of cases, the most common being asthenia (45.7%), hypothyroidism (25.7%) and cough (20.0%). For  pembrolizumab, the overall survival rate at the end of follow-up for first-  and second-line treatment was 100% and 70.9%, respectively. Median  progression-free survival was 17 months in the first-line and 24 months in  the second-line setting. Adverse events were observed in 84.4% of  subjects, the most common ones being dyspnea (31.3%), arthralgia  (28.1%) and asthenia (25.0%). The overall survival rate from 3 to 7  months remained at 75.8% for atezolizumab. Median progression-free  survival could not be determined. At 3 and 6 months, 49.5% of subjects  had made some progress. The most frequent adverse events included  toxicity (69.2%), asthenia (30.8%), and cough, dyspnea, and skin toxicity  (15.4% each). Conclusions: Subjects showed a trend toward stabilization and  chronification of the disease. A positive and considerable survival rate was observed, as compared with previous studies. Further studies are  required with larger sample sizes and longer follow-up times to confirm  these findings.