A Retrospective Analysis of Pembrolizumab With or Without Chemotherapy in Advanced Non-small Cell Lung Cancer: Experience From a Tertiary Care Hospital

TL;DR

This study examines how well pembrolizumab, with or without chemotherapy, works in treating advanced lung cancer in India, where such data is scarce.

Contribution

The study provides real-world evidence of pembrolizumab's effectiveness in India, a low-middle-income country, for advanced non-small cell lung cancer.

Findings

Combination therapy with pembrolizumab and chemotherapy improved progression-free survival compared to monotherapy.

Overall response rates were higher in patients receiving combination therapy.

Toxicity levels were consistent with known pembrolizumab adverse effects.

Abstract

Background: Pembrolizumab, an anti-PD-1 immune checkpoint inhibitor, has shown significant efficacy in advanced non-small cell lung cancer (NSCLC), either as monotherapy or in combination with chemotherapy. However, real-world data from low-middle-income countries, particularly India, are limited. This retrospective study investigates the clinical outcomes of 43 patients with advanced NSCLC treated with pembrolizumab with or without chemotherapy at Dharamshila Narayana Superspeciality Hospital, Delhi, India.

Methods: We performed a retrospective review of 43 patients with advanced NSCLC treated with pembrolizumab either alone or in combination with chemotherapy between January 2019 and December 2022. The primary endpoints were progression-free survival (PFS) and overall survival (OS), while secondary endpoints included overall response rates (ORR) and safety outcomes.

Results: The median PFS was 10.2 months in the entire cohort, with patients receiving combination therapy showing improved outcomes compared to monotherapy (12.5 months vs. 7.8 months). The ORR was higher in the combination therapy arm (54%) than in the monotherapy arm (32%). The toxicity profile was consistent with known adverse effects of pembrolizumab, with grade 3-4 events reported in 17% of patients.

Conclusions: The data suggest that pembrolizumab, with or without chemotherapy, is an effective and safe treatment option for advanced NSCLC in Indian patients, particularly in resource-constrained settings. Further prospective studies are warranted to confirm these findings.

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