Clin Oncol | Volume 7, Issue 1 | Research Article | Open Access

Are the Different Immunotherapies Used in Second Line Treatment of Metastatic Lung Cancer Equivalent?

Duplain C1, Bonniaud P2, Georges M2, Martin L3, Zouak A1,3, de Giraud D’Agay M4 and Foucher P1*

1Department of Thoracic Oncology, CHU, Dijon, France
2Department of Pulmonary Medicine, Intensive Care Unit, University Hospital, France
3Department of Anatomopathology, University Hospital, France
4Department of Hospital Epidemiology and Infection Control, Dijon University Hospital, France

*Correspondance to: Pascal Foucher 

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Background: Immune Checkpoint Inhibitors (ICIs) have changed the management of Non-Small Cell Lung Cancer (NSCLC). Nivolumab, pembrolizumab, and atezolizumab have been shown to be effective in second line treatment of metastatic NSCLC compared with docetaxel, improving response rate, Progression-Free Survival (PFS), Overall Survival (OS), and quality of life compared with chemotherapy.
Methods: This retrospective study was conducted from 2015 to 2021 on 165 patients with metastatic or locally advanced NSCLC in progression after a 1st line of chemotherapy without immunotherapy, who received a second line of ICIs at the University Hospital of Dijon.
Results: The response rate with nivolumab, pembrolizumab and atezolizumab was 15.7%, 16.3% and 5.4% respectively. Pembrolizumab had a better PFS (median of 190 days [28.5;604], p=0.0426) compared with the 2 other ICIs. There was no significant difference in OS between the 3 ICIs, even when survival analyses were performed with PDL1 ≥ 1. Incidence of grade ≥ 3 toxicities were 10.2%, 6.12%, and 3.1% with nivolumab, pembrolizumab, and atezolizumab respectively.
Conclusion: This study shows a better "real-life" PFS with pembrolizumab compared to nivolumab and atezolizumab in metastatic or locally advanced NSCLC progressing after 1st line chemotherapy. Atezolizumab appears to be less effective than the 2 others anti PD1 agents but offers less severe toxicities.


Immunotherapy; Non-small cell lung cancer; Second line; Efficacy


Duplain C, Bonniaud P, Georges M, Martin L, Zouak A, de Giraud D’Agay M, et al. Are the Different Immunotherapies Used in Second Line Treatment of Metastatic Lung Cancer Equivalent?. Clin Oncol. 2022;7:1972..

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