Second line advanced or metastatic non-small cell lung cancer treatment after chemo-immunotherapy: a retrospective study

With the shift to immunotherapy (IO) in first-line (1L) treatment for patients with advanced non-small cell lung cancer (aNSCLC), this study aims to describe second-line (2L) treatment patterns and outcomes. This retrospective study examined 2L outcomes in patients with stage IIIB-IV, epidermal growth factor receptor (EGFR)-/anaplastic lymphoma kinase (ALK) wild-type aNSCLC who started 1L therapy between 2016 and 2019 and received subsequent 2L therapy. Follow-up continued through November 2020. Subgroups included: 2L IO, 2L non-IO, and IO re-challenge (1L and 2L). A total of 194 patients initiated 2L therapy; 93 received IO (12 also in 1L), and 101 did not. For IO and non-IO, respectively: overall response rate (ORR) was 28.0% and 25.7%; median follow-up was 23.7 and 20.0 months; median realworld progression-free survival (rwPFS) was 8.4 and 5.1 months (<i>p</i> = 0.0006); median overall survival (OS) was 13.5 and 7.7 months (<i>p</i> = 0.0021). No deaths occurred in the IO re-challenge cohort after a median follow-up of 35.0 months. rwPFS and OS were consistent with clinical trials of 2L IO regimens. The few patients who received IO in 1L and 2L had favorable rwPFS and OS. Future research on sequential IO therapies in 1L and 2L aNSCLC is warranted. Over the past few decades, lung cancer research has greatly advanced our understanding of the disease. We now know that lung cancer is not just one type of cancer, but rather 20 or more unique types, each caused by different genetic mutations. For patients whose genetic tests do not find a specific target for treatment, immunotherapy (IO), often combined with chemotherapy, has become the preferred option. Our study focuses on understanding the outcomes of these patients outside of clinical trials. We used data from patients’ medical records, which were reviewed and abstracted by the doctors who treated them. We looked at patients who received IO or other treatments as their second option after their first treatment stopped working. We found that patients who received IO as their second treatment lived without their cancer getting worse for about 8.4 months, compared to 5.1 months for those who received other treatments. Overall, it was observed that patients who received IO lived for about 13.5 months, while those who received other treatments lived for about 7.7 months. A small group of patients who received IO both as their first and second treatment did not have any deaths during the study period. These findings may help doctors make better treatment decisions for patients who need a second treatment after their first one stops working, but more research is needed to confirm these results.