Clinical outcomes of nivolumab in patients with advanced non-small cell lung cancer in real-world practice, with an emph
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ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Clinical outcomes of nivolumab in patients with advanced non‑small cell lung cancer in real‑world practice, with an emphasis on hyper‑progressive disease Soo Han Kim1 · Chang‑Min Choi1,2 · Dae Ho Lee2 · Sang‑We Kim2 · Shinkyo Yoon2 · Woo Sung Kim1 · Wonjun Ji1 · Jae Cheol Lee2 Received: 14 March 2020 / Accepted: 13 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Although immune checkpoint inhibitors have been shown to be effective in many clinical trials, real-world data remain limited. We investigated the outcomes of non-small cell lung cancer (NSCLC) patients who received nivolumab, with an emphasis on hyper-progressive disease (HPD). Methods This retrospective study enrolled stage IV NSCLC patients who received nivolumab after progression on prior chemotherapy between July 2016 and June 2018 at a single center in Korea. HPD was defined by response evaluation criteria in solid tumors as progression at the first evaluation, with a ≥ two-fold increase in the tumor growth rate during nivolumab treatment. Results A total of 83 patients with a median age of 60 years were enrolled [squamous, 25(30%) and non-squamous, 58(70%)]. The median progression-free survival (PFS) and overall survival (OS) were 2.6 months [95% confidence interval (CI) 0.82–4.31] and 8.6 months (95% CI 5.56–11.59), respectively. HPD developed in 16 (19.2%). The median OS of HPD patients was 2.2 months (95% CI 0.92–3.75) compared with 4.1 months for progressive disease (PD) patients without HPD (95% CI 1.54–6.67). Among patients with pleura or pericardium metastasis, increased effusion was seen more frequently in HPD patients compared with PD patients without HPD [90% (9/10) vs. 28.6% (4/14); p = 0.005]. HPD patients also showed a significant decrease in circulating albumin after treatment with nivolumab (p = 0.030). Conclusion Although the efficacy of nivolumab in real-world patients was comparable to that seen in clinical trials, clinicians should be aware of HPD because it is not uncommon and represents a worse prognosis. Keywords Immune checkpoint inhibitor · Efficacy · Hyper-progression · Pleura · Albumin
Introduction All authors meet the ICMJE authorship criteria. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00432-020-03293-9) contains supplementary material, which is available to authorized users. * Wonjun Ji [email protected] * Jae Cheol Lee [email protected] 1
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic‑ro 43‑gil, Songpa‑gu, Seoul 05505, Korea
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic‑ro 43‑gil, Songpa‑gu, Seoul 05505, Korea
2
Global estimates suggest that lung cancer is the cause of death of more than 1.5 million people each year, and it ranks as one of the leading causes of cancer-related deaths worldwide (Cheng et al. 2016). Most cases (85–90%) are non-s
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