Immune Checkpoint Inhibitors for Patients With Advanced Lung Cancer and Oncogenic Driver Alterations

Results From the IMMUNOTARGET Registry

J. Mazieres; A. Drilon; A. Lusque; L. Mhanna; A. B. Cortot; L. Mezquita; A. A. Thai; C. Mascaux; S. Couraud; R. Veillon; M. Van den Heuvel; J. Neal; N. Peled; M. Früh; T. L. Ng; V. Gounant; S. Popat; J. Diebold; J. Sabari; V. W. Zhu; S. I. Rothschild; P. Bironzo; A. Martinez-Marti; A. Curioni-Fontecedro; R. Rosell; M. Lattuca-Truc; M. Wiesweg; B. Besse; B. Solomon; F. Barlesi; R. D. Schouten; H. Wakelee; D. R. Camidge; G. Zalcman; S. Novello; S. I. Ou; J. Milia; O. Gautschi

Disclosures

Ann Oncol. 2019;30(8):1321-1328. 

In This Article

Patients and Methods

Study objectives

The primary objective of our study was to describe the progression-free survival (PFS) of patients treated with PD1/PD-L1 checkpoint inhibitors (ICI) in each subgroup carrying an oncogenic driver. The secondary objectives were both the best overall response (that was not confirmed by a second measurement) and the OS for each molecular subgroup. We also analyzed the outcome of patients according to smoking status, line of treatment, and PD-L1 expression.

Patients' Selection

A global multicenter network of thoracic oncologists accrued patients in this registry. Investigators were identified via an ongoing collaboration established by our prior registries.[14–18] Eligible patients had (i) a pathologic diagnosis of lung cancer; (ii) local testing positive (either direct sequencing or NGS on validated platforms) for at least one oncogenic driver mutation: EGFR (exon 18–21) activating mutation, HER2 (exon 20) activating mutation, KRAS mutation, BRAF (exon 15) mutation, MET amplification or exon 14 mutation, ALK rearrangement, ROS1rearrangement or RET rearrangement; (iii) single agent ICI therapy with commercial anti-PD1/PD-L1-antibodies; (iv) local response assessment according to RECIST1.1 criteria; (v) follow-up with survival status. Optionally, investigators were asked to record immunotherapy-related adverse events (irAE) and PD-L1 expression in tumor cells.

PD-L1 Analysis

PD-L1 analysis was carried out in each center according to local procedures. Antibodies used were E1L3N (32.8%), SP142 (31.7%), 22C3 (22.2%), SP263 (6.7%), 28–8 (5.6%), and others (1.1%). Results were provided in percentage of staining of tumor cells with three cut-off levels: 1%, 10%, and 50%.

Ethical Considerations

The study was approved by the national ethics committees of France (CEPRO 2017–043, CNIL Nh22181405I) and Switzerland (Swissethics/EKNZ ID 2017–01530). Participating centers were responsible for patients' consent and institutional approval. All contributors were trained in Good Clinical Practice. The study was a purely academic collaboration granted by both Toulouse and Lucerne Hospitals and was not funded by industry.

Data Collection and Response Assessment

Anonymized clinical data were recorded by local investigators using electronic case report forms (eCRF) in a password-protected secure online portal from the University of Toulouse (https://ec.claudiusregaud.fr/CSOnline/). Data were centrally collected at the University of Toulouse (France). The registry was open for enrollment from May 2017 until April 2018. Best response to systemic therapies, defined as a complete or partial response achieved at least once during the course of therapy, was assessed locally using RECIST v1.1 criteria.

Statistical Methods

All statistical evaluations were carried out according to the predefined plan as stated in the protocol. Data were summarized according to frequency and percentage for qualitative variables, and by median and range for quantitative variables. The 95% confidence interval for response rate was calculated using the exact binomial distribution. PFS was measured as the time from the first administration of ICI therapy to progression defined by RECIST1.1, or death due to any cause. Patients alive without progression at the time of analysis were censored at the initiation of a new therapy or last follow-up. OS was measured as the time from the first administration of ICI therapy to death due to any cause. Patients alive at the time of analysis were censored at the last follow-up. Survival data were estimated using the Kaplan–Meier method and compared using the log-rank test in overall cohort and oncogenic driver subgroups. Statistical analyses were carried out using STATA 13.1 software (StataCorp, TX).

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