Brief report: immune checkpoint inhibitors use in lung cancer: a real-world outcome study in a middle-income country

Lung cancer is the leading cause of cancer death in the world and its treatment represents a major challenge. Treatment with immune checkpoint inhibitors (ICIs) uses cutting-edge technologies and mobilizes a large number of clinical research players. However, the cost may be a barrier to access to these treatments in developing countries. The objective of this study was to evaluate the use of ICIs in lung cancer and assess real-world data of this treatment in Morocco. This is a retrospective, multicenter cohort study conducted in a Moroccan population diagnosed with lung cancer between January 2019 and January 2022 and treated with ICIs. Patients were recruited from public and private oncology centers of the whole kingdom. Agreement of the ethics committee has been obtained. Survival data, response rates and time till discontinuation of treatment were evaluated using the chi-square test and bivariate analyzes. We included 158 cases representing 5 % of the total number of patients with advanced lung cancer who were eligible for treatment with ICIs. The mean age of patients was 62.48 years and the sex ratio (male/female) was of 4.41. Seventy percent of patient had non-squamous cell carcinoma. EGFR status was mutated in 3.9% of the cases. In 34.2% of the cases, the PD-L1 expression status was not known. Forty-seven percent of patients were treated with ICIs monotherapy. Fifty-eight percent of ICIs prescription was in the frontline treatment of lung cancer. The median time to discontinuation of treatment was 13.53 months. The 12-month overall survival rate was 71.1% (95% CI: 62.5-79.7%). The median overall survival was 17 months (95% CI: 14-20 months). Patients with PD-L1 tumor proportion scores (TPS) $$\ge$$ 50% had a higher median OS of 24 months compared to 14 months in PD-L1-negative cases. Adverse events were reported in 40% of patients, with 9.3% experiencing grade 3 or 4 toxicities, including pneumonitis (3%), diarrhea (2%), and transaminitis (1.5%). These results highlight the efficacy of immune checkpoint inhibitors (ICIs) in a real-world Moroccan setting while emphasizing the need to address barriers like biomarker testing and access to improve outcomes further.