Multicenter retrospective cohort study of subsequent treatments and outcomes after two years of pembrolizumab for advanced non-small cell lung cancer

Two years of immunotherapy is the standard treatment for most patients with advanced non-small cell lung cancer (aNSCLC). Little is known about postimmunotherapy therapeutic strategies. A multicenter retrospective study in France included patients who received a diagnosis of incident aNSCLC between 2015 and 2022, who received pembrolizumab for 22 to 26 months, and survived at least 29 months (landmark). Among 41,498 patients who received frontline pembrolizumab for advanced disease, 5293 were alive at the landmark time and completed 2 years of treatment, and 1555 discontinued pembrolizumab at 2 years. The population of interest for this study included 1480 patients with at least 6 months of follow-up. After a median follow-up of 16 months after the landmark, the overall survival rate at 48 months was 76.9% (95% CI 72.7-81.3), and the time to next treatment or death rate at 48 months after pembrolizumab discontinuation was 49.9% (45.3-55.0). Overall, 387 patients (26.1%) received subsequent therapy. The first treatments after pembrolizumab discontinuation were chemotherapy (51.7%), radiotherapy (47.3%), and immunotherapy (1.0%); twelve months after initiation of these new treatments, the OS rates were 87.0% for radiotherapy, 69.9% for chemotherapy, and 61.4% for immunotherapy. The authors conclude that among long-term aNSCLC survivors who received pembrolizumab, survival outcomes were favorable and immunotherapy rechallenge was uncommon.