ABO‐Blood Group Associates With Survival Outcomes in Patients With Metastatic Non‐Small Cell Lung Cancer Treated With Pembrolizumab Monotherapy
Purpose: In patients with metastatic non-small cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression, there is still a lack of biomarkers to identify patients with maximum benefit from first-line treatment with checkpoint inhibitor therapy (CIT) alone. This work examines the impact of different ABO blood groups (BG) on the response to CIT monotherapy.
Methods: Retrospective analysis of patients with stage IV NSCLC and high PD-L1 expression (tumor proportional score/TPS ≥ 50%), receiving first-line therapy with pembrolizumab alone or in combination with chemotherapy at the West German Cancer Center from 2017 to 2022. Study endpoints were overall survival (OS) and progression-free survival (PFS).
Results: Eighty-two patients were included in the analysis. Twenty-two patients (27%) received first-line therapy with pembrolizumab alone (monoimmunotherapy cohort/MIC), of which seven patients (32%) had BGO. Sixty patients (73%) were treated with pembrolizumab combined with platinum-based chemotherapy (chemoimmunotherapy cohort/CIC), of which 38 (63%) had BGO. In MIC, younger age and BGO were independent predictors of favorable OS (BGO vs. other ABO-BG: HR 0.22, 95% CI: 0.1-0.9; p = 0.037; median OS 62 versus 19 months) and PFS (BGO vs. other ABO-BG: HR 0.21, 95% CI: 0.1-0.8; p = 0.024; median PFS 39 vs. 4 months). There was no significant impact of ABO-BG in patients treated with CIC. In support, a historical control group treated with chemotherapy alone also showed no prognostic impact of the ABO-BG.
Conclusion: BGO associates with favorable survival in patients with NSCLC receiving pembrolizumab monotherapy, but not in patients with chemo-immunotherapy or chemotherapy. Further validation of this promising strategy for personalized decision-making is warranted.
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