PD-L1 score as a prognostic biomarker in Asian patients with early-stage, EGFR-mutated lung cancer.

Authors

null

Stephanie Saw

National Cancer Centre Singapore, Singapore, Singapore

Stephanie Saw , Gillianne Lai , Aaron C. Tan , Siqin Zhou , Mei-Kim Ang , Wan-Teck Lim , Ravindran Kanesvaran , Wan Ling Tan , Tanujaa Rajasekaran , Johan Chan , Yi Lin Teh , Boon-Hean Ong , Angela M. Takano , Eng Huat Tan , Sze Huey Tan , Daniel Shao-Weng Tan

Organizations

National Cancer Centre Singapore, Singapore, Singapore, National Heart Centre Singapore, Singapore, Singapore, Singapore General Hospital, Singapore, Singapore

Research Funding

Other Government Agency

Background: Adjuvant Atezolizumab was recently approved in stage II-IIIA non-small cell lung cancer (NSCLC) with PD-L1 ≥1%. However, disease-free survival (DFS) benefit was mainly driven by PD-L1 ≥50% and among EGFR-mutated subgroup, atezolizumab did not demonstrate DFS benefit when PD-L1 0% patients were included. We sought to determine the prognostic value of PD-L1 score in early-stage EGFR-mutated NSCLC. Methods: Consecutive patients with Stage IA-IIIA NSCLC diagnosed 1/1/2010 – 31/12/2019 who underwent curative surgery at National Cancer Centre Singapore with evaluable EGFR and PD-L1 status were included. Co-primary endpoints were 2-year DFS and 5-year overall survival (OS) by Kaplan-Meier method. Results: 455 patients were included (267 EGFR-mutant; 188 EGFR-wildtype). Median age at diagnosis was 65 years, 52.3% (238/455) were males and 62.9% (286/455) were never-smokers. Adenocarcinomas comprised 92.1% (419/455) and 92.5% (421/455) had R0 resection. Stage IA comprised 42.4% (193/455), Stage IB 23.1% (105/455), Stage II 15.8% (72/455) and Stage IIIA 18.7% (85/455). Among EGFR-mutant, 45.3% (121/267) were Ex19del and 41.9% (112/267) were L858R. PD-L1 ≥1% among EGFR-mutant and EGFR-wildtype was 55.8% (149/267) and 60.1% (113/188) respectively (p = 0.361). PDL1 ≥50% was significantly associated with higher stage at diagnosis among EGFR-mutant (p < 0.001) but not EGFR-wildtype (p = 0.319). At median follow up of 47 months, 178 patients had relapsed. Among EGFR-mutant, 2-year DFS comparing PD-L1 0% and PD-L1 ≥1% was 79.0% and 68.9% (p = 0.006) while 5-year OS was 87.6% and 70.6% (p = 0.006) respectively. 2-year DFS and 5-year OS by PD-L1 tertile (as shown in table) revealed that higher PD-L1 score was prognostically worse for both DFS and OS among EGFR-mutant. A similar trend was observed among EGFR-wildtype but did not reach statistical significance, apart from PD-L1 ≥50% which had significantly inferior DFS. Conclusions: Higher PD-L1 score was significantly associated with worse DFS and OS among early-stage EGFR-mutated NSCLC, possibly due to higher stage at diagnosis among PDL1 ≥50%. Our study highlights the poor prognosis of PDL1 ≥50% EGFR-mutated NSCLC in a pre-osimertinib era and underscores the importance of personalised risk-stratified adjuvant strategies.



2-year DFS (95% CI)
HR (95% CI)
p value
5-year OS (95% CI)
HR (95% CI)
p value
EGFR-mutant
PD-L1 0%
(n = 118)
79.0%
(70.3%-85.4%)
1

87.6%
(77.4%-93.4%)
1

PD-L1 1-49%
(n = 133)
71.9%
(63.4%-78.8%)
1.58
(1.06-2.36)
0.025
70.6%
(56.5%-80.9%)
2.38
(1.18-4.82)
0.016
PD-L1 ≥50%
(n = 16)
43.8%
(19.8%-65.6%)
2.89
(1.51-5.53)
0.001
68.7%
(34.3%-87.7%)
3.14
(1.17-8.43)
0.023
EGFR-wildtype
PD-L1 0%
(n = 75)
76.8% (65.3%-84.9%)
1

76.9%
(62.5%-86.4%)
1

PD-L1 1-49%
(n = 71)
70.6%
(58.3%-80%)
1.41
(0.85-2.35)
0.179
61.7%
(42.9%-75.9%)
1.17
(0.61-2.21)
0.639
PD-L1 ≥50%
(n = 42)
42.2% (26.8%-56.8%)
2.22
(1.30-3.81)
0.004
57.2%
(39.6%-71.4%)
1.64
(0.85-3.17)
0.141

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Biologic Correlates

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 8527)

DOI

10.1200/JCO.2022.40.16_suppl.8527

Abstract #

8527

Poster Bd #

154

Abstract Disclosures