Immunotherapy has revolutionised the management of advanced NSCLC. We report our experience using nivolumab beyond the first-line setting in a regional Australian cancer care centre.
We performed a retrospective review of patients treated with nivolumab for recurrent or metastatic NSCLC who experienced disease progression on first-line chemotherapy at the Illawarra and Shoalhaven Cancer Care Centres between 25th June 2015 and 1st May 2017. Kaplan-Meier analysis was used to determine progression-free survival (PFS) and overall survival (OS).
77 patients were included in analysis. The median age was 69 years (range 47-94), and 20 patients (26%) were aged 75 or older. Most patients were stage IV (83%), had non-squamous histopathology (71%) and received only one previous line of treatment (91%). Median PFS was 5.33 months (95%CI:3.2–8.5) and median OS was 13.4 months (95%CI:6.2–not reached). In those who were aged 75 or older, median PFS was 4.9 months (95%CI:1.3–10.1) and median OS was 5.9 months (95%CI:0.9–not reached). Overall response rate was 32%. The number of previous systemic treatment lines (≥2 vs 1 line) was the only factor significantly associated with shorter PFS (univariate p=0.04, median PFS 1.9 vs 5.6 months). The most prevalent toxicities of any grade were fatigue, anorexia, nausea and diarrhoea, with low rates of immune-related toxicities such as thyroiditis (8%), pneumonitis (3%), adrenal insufficiency (3%) and hepatitis (4%). 48% of patients received steroids whilst on treatment, and this was not associated with a change in PFS (p=0.8)
In a real world population based in regional Australia, the use of nivolumab in patients with advanced NSCLC produced survival outcomes comparable to those reported in the literature, despite high rates of steroid use. The slightly increased rates of toxicity highlights a need for further research into the safety of immunotherapy in this population.