Real-world survival of patients treated with taxane therapy after exposure to immunotherapy and platinum-based chemotherapy for advanced non-small-cell lung cancer without actionable mutations

Background

The current therapy for advanced non-small-cell lung cancer (NSCLC) often incorporates frontline use of programmed death (ligand) 1 [PD-(L)1] inhibitors concomitantly or sequentially with platinum-based chemotherapy. For patients whose cancer then progresses, the impact of prior immunotherapy on the efficacy of subsequent chemotherapy remains unclear. This retrospective study aimed to evaluate survival with taxane-containing regimens after prior chemotherapy and immunotherapy.

Methods

Using a US nationwide, longitudinal deidentified database, we selected patients ≥18 years old with unresectable stage IIIB-IV NSCLC, without actionable mutations, who had ECOG performance status of 0-1 when initiating a taxane-containing regimen from 4 March 2015 to 31 May 2021 after prior PD-(L)1 inhibitor and platinum-based chemotherapy, concomitantly or sequentially. Overall survival (OS) was estimated using the Kaplan-Meier method. The data cut-off was 31 May 2022.

Results

Of 587 eligible patients [median age, 68 years, 316 (54%) male, 560 (95%) with nonsquamous NSCLC], 528 (90%) had received one to two prior lines of therapy before taxane monotherapy (195 patients; 33%) or combination therapy (392; 67%). The median patient follow-up to death or data cut-off was 9.2 months (range <0.1-71.8 months). The median OS from taxane initiation was 9.0 months [95% confidence interval (CI) 8.1-9.6 months] and OS rates were 39% and 16% at 12 and 24 months, respectively. The median OS was similar with taxane monotherapy (9.0 months; 95% CI 8.1-11.2 months) and taxane combination therapy (8.8 months; 95% CI 7.5-9.6 months).

Conclusions

Survival with taxane-containing regimens after prior chemotherapy and immunotherapy is consistent with historical outcomes that predate immunotherapy. These findings highlight the need for more effective subsequent treatments after prior PD-(L)1 inhibitor and platinum-based chemotherapy for patients with advanced NSCLC without actionable mutations.