Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly Dosing
Background: A fixed dose of 200 mg of pembrolizumab every 3 weeks (Q3W) is the standard of care for patients with stage IV non-small cell lung cancer (NSCLC) and PDL1 ≥50%. In April 2020, based on pharmacokinetic modeling without formal comparative studies, the FDA approved 400 mg every 6 weeks (Q6W...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/29/11/685 |
| _version_ | 1827644759591616512 |
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| author | Lauren Jones Rebekah Rittberg Bonnie Leung Aria Shokoohi Alexandra Pender Selina Wong Zamzam Al-Hashami Ying Wang Cheryl Ho |
| author_facet | Lauren Jones Rebekah Rittberg Bonnie Leung Aria Shokoohi Alexandra Pender Selina Wong Zamzam Al-Hashami Ying Wang Cheryl Ho |
| author_sort | Lauren Jones |
| collection | DOAJ |
| description | Background: A fixed dose of 200 mg of pembrolizumab every 3 weeks (Q3W) is the standard of care for patients with stage IV non-small cell lung cancer (NSCLC) and PDL1 ≥50%. In April 2020, based on pharmacokinetic modeling without formal comparative studies, the FDA approved 400 mg every 6 weeks (Q6W). Pharmacokinetic studies also suggested comparable target engagement with weight-based and flat dosing for the respective schedules. The objective of this study was to determine if overall survival (OS) differs based on the Q3W vs. Q6W dosing schedule of pembrolizumab. Methods: BC Cancer patients with stage IV NSCLC and PDL1 ≥50% treated with pembrolizumab were retrospectively reviewed. Patients were treated with weight-based dosing, per institution standard, of pembrolizumab 2 mg/kg Q3W or 4 mg/kg Q6W. Patient demographics, treatment and outcome were recorded. Patients were assigned to Q3W or Q6W according to the schedule that was used for the majority of treatment (greater than 50%). Results: 718 patients with NSCLC and PDL1 ≥50% received first-line pembrolizumab between 2017 and2021, Q3W/Q6W dosing 677/41 patients. Baseline characteristics with respect to age, sex, smoking status, histology and performance status (PS) were similar between groups. In the multivariate model, including age, sex, PS and dosing schedule, the hazard ratio for death (HR) for OS Q3W vs. Q6W was 0.759 (<i>p</i> = 0.230). A 2:1 case-matched analysis for OS was performed, controlling for sex, age ± 5 years, PS and duration on pembrolizumab ± 2 months for Q3W vs. Q6W (<i>n</i> = 113) with a HR 0.834 (<i>p</i> = 0.500). Conclusions: There was no OS difference demonstrated with pembrolizumab dosing Q3W compared to Q6W in a multivariate analysis that included age, sex and PS. A case-matched analysis that controlled for these variables and for duration of treatment confirmed these findings. This study supports the use of Q6W pembrolizumab dosing, allowing for less frequent interactions with the medical system. |
| first_indexed | 2024-03-09T18:24:54Z |
| format | Article |
| id | doaj.art-e00a766de58841df86bd311c86c0dc6b |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T18:24:54Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-e00a766de58841df86bd311c86c0dc6b2023-11-24T08:03:12ZengMDPI AGCurrent Oncology1198-00521718-77292022-11-0129118686869210.3390/curroncol29110685Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly DosingLauren Jones0Rebekah Rittberg1Bonnie Leung2Aria Shokoohi3Alexandra Pender4Selina Wong5Zamzam Al-Hashami6Ying Wang7Cheryl Ho8Department of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, CanadaDepartment of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, CanadaDepartment of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, CanadaFaculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, CanadaDepartment of Medical Oncology, The Royal Free NHS Foundation Trust, London NW3 2QG, UKDepartment of Medical Oncology, BC Cancer, Victoria, BC V8R 6V5, CanadaDepartment of Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat 111, OmanDepartment of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, CanadaDepartment of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, CanadaBackground: A fixed dose of 200 mg of pembrolizumab every 3 weeks (Q3W) is the standard of care for patients with stage IV non-small cell lung cancer (NSCLC) and PDL1 ≥50%. In April 2020, based on pharmacokinetic modeling without formal comparative studies, the FDA approved 400 mg every 6 weeks (Q6W). Pharmacokinetic studies also suggested comparable target engagement with weight-based and flat dosing for the respective schedules. The objective of this study was to determine if overall survival (OS) differs based on the Q3W vs. Q6W dosing schedule of pembrolizumab. Methods: BC Cancer patients with stage IV NSCLC and PDL1 ≥50% treated with pembrolizumab were retrospectively reviewed. Patients were treated with weight-based dosing, per institution standard, of pembrolizumab 2 mg/kg Q3W or 4 mg/kg Q6W. Patient demographics, treatment and outcome were recorded. Patients were assigned to Q3W or Q6W according to the schedule that was used for the majority of treatment (greater than 50%). Results: 718 patients with NSCLC and PDL1 ≥50% received first-line pembrolizumab between 2017 and2021, Q3W/Q6W dosing 677/41 patients. Baseline characteristics with respect to age, sex, smoking status, histology and performance status (PS) were similar between groups. In the multivariate model, including age, sex, PS and dosing schedule, the hazard ratio for death (HR) for OS Q3W vs. Q6W was 0.759 (<i>p</i> = 0.230). A 2:1 case-matched analysis for OS was performed, controlling for sex, age ± 5 years, PS and duration on pembrolizumab ± 2 months for Q3W vs. Q6W (<i>n</i> = 113) with a HR 0.834 (<i>p</i> = 0.500). Conclusions: There was no OS difference demonstrated with pembrolizumab dosing Q3W compared to Q6W in a multivariate analysis that included age, sex and PS. A case-matched analysis that controlled for these variables and for duration of treatment confirmed these findings. This study supports the use of Q6W pembrolizumab dosing, allowing for less frequent interactions with the medical system.https://www.mdpi.com/1718-7729/29/11/685PDL1pembrolizumabdosing scheduleNSCLC |
| spellingShingle | Lauren Jones Rebekah Rittberg Bonnie Leung Aria Shokoohi Alexandra Pender Selina Wong Zamzam Al-Hashami Ying Wang Cheryl Ho Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly Dosing Current Oncology PDL1 pembrolizumab dosing schedule NSCLC |
| title | Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly Dosing |
| title_full | Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly Dosing |
| title_fullStr | Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly Dosing |
| title_full_unstemmed | Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly Dosing |
| title_short | Alternate Pembrolizumab Dosing Interval in Advanced NSCLC with PD-L1 TPS ≥ 50%: 3 Weekly Compared to 6 Weekly Dosing |
| title_sort | alternate pembrolizumab dosing interval in advanced nsclc with pd l1 tps ≥ 50 3 weekly compared to 6 weekly dosing |
| topic | PDL1 pembrolizumab dosing schedule NSCLC |
| url | https://www.mdpi.com/1718-7729/29/11/685 |
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