1. Introduction
NSCLC, tumor, death, non-small-cell lung cancer, Lung cancer, PD, primary lung tumor
DISEASE PROGRESSION, TUMOR, METASTASIS, DISEASE, LUNG CANCER, NSCLC, REGRESSION, PATHOLOGY
These authors contributed equally to this work.Health Canada approved pembrolizumab in the first-line setting for advanced non-small-cell lung cancer with PD-L1 ≥ 50% and no EGFR/ALK aberration. The keynote 024 trial showed 55% of such patients progress with pembrolizumab monotherapy. We propose that the combination of baseline CT and clinical factors can help identify those patients who may progress. In 138 eligible patients from our institution, we retrospectively collected their baseline variables, including baseline CT findings (primary lung tumor size and metastatic site), smoking pack years, performance status, tumor pathology, and demographics. The treatment response was assessed via RECIST 1.1 using the baseline and first follow-up CT. Associations between the baseline variables and progressive disease (PD) were tested by logistic regression analyses. The results showed 46/138 patients had PD. The baseline CT “number of involved organs” by metastasis and smoking pack years were independently associated with PD (Lung cancer remains the leading cancer-related death globally, with the 5-year survival at 22% [The KN024 trial demonstrated that pembrolizumab monotherapy improved the overall response rate (ORR) and overall and progression-free survival (OS and PFS) compared to platinum doublet chemotherapy (PDC) in the first-line setting for advanced NSCLC patients with a high PDL1 expression (i.e., ≥50%) and no EGFR/ALK aberration [The goal of this study was to identify, in advanced NSCLC patients with PD-L1 ≥ 50% and no EGFR/ALK aberration, which baseline features could predict a patient’s future disease progression assessed radiographically at the first follow-up CT. There have been no clinical radiologic studies that have specifically correlated the baseline CT disease features to the treatment response. We propose that the combination of a patient’s baseline CT findings and clinical factors, including smoking pack years, can predict the treatment response and can be used to guide first-line treatment decisions in this PD-L1 high cohort.