Clinical features and prognosis analysis of stage III/IV patients with lung cancer after treatment with toripalimab: A real-world retrospective

Abstract

Aim: Toripalimab is the first antitumor programmed cell death protein 1 (PD-1) antibody approved in China. For better patient management, it is important to understand the real-world outcomes of toripalimab in treating patients with lung cancer in the real world outside of clinical trials to improve patient care.

Methods: We retrospectively examined the clinical data of 80 patients with lung cancer who received the PD-1 inhibitor (toripalimab). The Chi-square test was performed to identify clinical factors associated with the advancement of the disease. Multivariate Cox regression analysis was used to screen prognostic variables linked to real-world progression-free survival (PFS) and overall survival (OS). OS and PFS were calculated using the Kaplan-Meier method, and the comparisons were determined using the log-rank test, and continuous and categorical variables were explained using median and percentage, respectively.

Result: The median OS of the estimated 80 patients was 15.85 months (95% confidence interval [CI]: 14.103-17.949 months), and the estimated PFS was 5.650 months (95% CI: 7.226-11.264 months). The longer OS and PFS correlate with the patient's staging and number of treatment lines. The PD-1 drug gave stage III patients a significantly longer PFS and OS compared to stage IV patients (PFS: 14.65 vs. 6.68, P = 0.004; OS: 21.1 vs. 13.7, P = 0.003). First- or second-line immunotherapy patients have significantly longer PFS and OS than third- or fourth-line (PFS: 6.4 vs. 3.6, P = 0.009; OS: 20.0 vs. 10.5, P = 0.003). In patients with stage IV (n = 60) with extensive metastasis, the site of metastasis is mostly 1-3 sites after receiving toripalimab. The duration of PD-1 inhibitor OS in progressive patients (n = 56) was significantly prolonged (P = 0.038).

Conclusion: For patients with lung cancer, toripalimab can considerably extend PFS and OS in the first or second line and in stage III. PD-1 inhibitors are administered to patients with stage IV extensively metastatic lung cancer, which indicates an oligometastatic progression pattern, primarily in 1-3 locations, who are treated with PD-1 inhibitors. Continuing toripalimab beyond disease progression significantly prolonged OS.