106P Immunotherapy after progression to double immunotherapy: Pembrolizumab and lenvatinib versus conventional chemotherapy for patients with metastatic melanoma after failure of PD-1/CTLA-4 inhibition

Background: Although checkpoint inhibitors have improved first-line treatment for nonesmall cell lung cancer (NSCLC), a therapeutic need remains for patients whose disease does not respond or who experience disease progression after anti-PD-L1/PD-1 immunotherapy.Cadonilimab (AK104) is a bispecific antibody targeting PD-1 and CTLA-4 simultaneously.Here, we reported the efficacy and safety of cadonilimab with or without single-agent chemotherapy as a second-or later-line setting for metastatic NSCLC who developed disease progression after checkpoint inhibitor and chemotherapy. Methods:The study population derived from retrospectively analyzed data (08/2022-04/2024) of patients treated with cadonilimab as second-or later-line therapy for metastatic NSCLC at Affiliated Hospital of Guangdong Medical University.Baseline characteristics, treatment patterns, and clinical outcomes, including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and treatment-related adverse events (TRAEs) were analyzed.Results: 21 patients were enrolled, of which 11 (52.3%) received cadonilimab as a third or later line therapy.The median age was 66 years old (range: 54-87), 16 (76.2%)were male, 10 (47.6%) had ECOG PS 2 or 3, and 4 (19.0%) had brain metastasis.Among evaluable patients, 5 reached partial response (PR) and 9 were stable disease (SD).The ORR was 29.4% and DCR was 82.4%.The median PFS was 6.77 months (95% confidence interval: 5.28-8.27)and median OS was not mature.Three patients (14.3%) experienced grade3 TRAEs.The most common TRAEs (10%) included anemia (42.9%), hypoleukocytosis (28.6%), and aspartate aminotransferase increased (19.1%), hypothyroidism(14.3%),alanine aminotransferase increased(14.3%).No treatment-related deaths were reported.Conclusions: This real-world analysis further confirmed the promising efficacy and safety of cadonilimab as a second-or later-line setting for metastatic NSCLC who developed disease progression after checkpoint inhibitor and chemotherapy.Further exploration is ongoing and the updated analysis in a larger population is expected in the future.