Efficacy of first-line treatments for advanced pulmonary sarcomatoid carcinomas: a real-world analysis
Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) wit...
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| Published in | ESMO open Vol. 10; no. 8; p. 105343 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.08.2025
European Society for Medical Oncology Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2059-7029 2059-7029 |
| DOI | 10.1016/j.esmoop.2025.105343 |
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| Abstract | Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs).
Using the French Epidemiological Strategy and Medical Economics Lung Cancer (ESME-LC) database (2015-2022), we analyzed APSC patients’ first-line ICI ± ChT or ChT outcomes, then applied propensity score weighting to indirectly compare them.
Among 42 219 patients with untreated lung cancers, 229 (0.5%) had APSCs. One hundred and sixty-one (70.3%) received first-line treatment (43 ICI alone, 24 ICI + ChT, 94 ChT alone): median age, 66 years; 70.2% men; 69.8% Eastern Cooperative Oncology Group performance status 0/1, among 106 available values; 86.2% smokers or former smokers. Molecular testing was done for 113/161 (70.2%) patients, 35.4% of whom had a molecular abnormality, most frequently a KRAS mutation (39.7%). Programmed death-ligand 1 tumor proportion scores determined for 43.5% of tumors (70/161) were: 68.6% ≥50%, 8.6% 1%-49%, and 22.9% <1%. For the ICI ± ChT group, median PFS and OS were 4.6 months [95% confidence interval (CI) 2.1-8.2 months] and 20.6 months (95% CI 10.3-32.4 months), respectively. For ChT-alone recipients, median PFS and OS were 2.2 months (95% CI 2.0-3.0 months) and 6.8 months (95% CI 4.3-10.0 months), respectively. Applying a propensity score, ICI ± ChT was significantly associated with longer PFS (HR 0.46, 95% CI 0.29-0.72, P < 0.001) and longer OS (HR 0.46, 95% CI 0.28-0.74, P = 0.002) than ChT alone.
According to this real-world analysis, first-line ICI ± ChT seems to have considerably improved the prognosis of APSCs.
•First-line ICI ± ChT for advanced pulmonary sarcomatoid carcinoma (APSC) prolongs PFS and OS versus ChT alone.•KRAS and MET mutations are frequent in APSC.•ICI ± ChT appears to be a promising first-line therapy for APSC. |
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| AbstractList | Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs).
Using the French Epidemiological Strategy and Medical Economics Lung Cancer (ESME-LC) database (2015-2022), we analyzed APSC patients’ first-line ICI ± ChT or ChT outcomes, then applied propensity score weighting to indirectly compare them.
Among 42 219 patients with untreated lung cancers, 229 (0.5%) had APSCs. One hundred and sixty-one (70.3%) received first-line treatment (43 ICI alone, 24 ICI + ChT, 94 ChT alone): median age, 66 years; 70.2% men; 69.8% Eastern Cooperative Oncology Group performance status 0/1, among 106 available values; 86.2% smokers or former smokers. Molecular testing was done for 113/161 (70.2%) patients, 35.4% of whom had a molecular abnormality, most frequently a KRAS mutation (39.7%). Programmed death-ligand 1 tumor proportion scores determined for 43.5% of tumors (70/161) were: 68.6% ≥50%, 8.6% 1%-49%, and 22.9% <1%. For the ICI ± ChT group, median PFS and OS were 4.6 months [95% confidence interval (CI) 2.1-8.2 months] and 20.6 months (95% CI 10.3-32.4 months), respectively. For ChT-alone recipients, median PFS and OS were 2.2 months (95% CI 2.0-3.0 months) and 6.8 months (95% CI 4.3-10.0 months), respectively. Applying a propensity score, ICI ± ChT was significantly associated with longer PFS (HR 0.46, 95% CI 0.29-0.72, P < 0.001) and longer OS (HR 0.46, 95% CI 0.28-0.74, P = 0.002) than ChT alone.
According to this real-world analysis, first-line ICI ± ChT seems to have considerably improved the prognosis of APSCs.
•First-line ICI ± ChT for advanced pulmonary sarcomatoid carcinoma (APSC) prolongs PFS and OS versus ChT alone.•KRAS and MET mutations are frequent in APSC.•ICI ± ChT appears to be a promising first-line therapy for APSC. Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs). Using the French Epidemiological Strategy and Medical Economics Lung Cancer (ESME-LC) database (2015-2022), we analyzed APSC patients' first-line ICI ± ChT or ChT outcomes, then applied propensity score weighting to indirectly compare them. Among 42 219 patients with untreated lung cancers, 229 (0.5%) had APSCs. One hundred and sixty-one (70.3%) received first-line treatment (43 ICI alone, 24 ICI + ChT, 94 ChT alone): median age, 66 years; 70.2% men; 69.8% Eastern Cooperative Oncology Group performance status 0/1, among 106 available values; 86.2% smokers or former smokers. Molecular testing was done for 113/161 (70.2%) patients, 35.4% of whom had a molecular abnormality, most frequently a KRAS mutation (39.7%). Programmed death-ligand 1 tumor proportion scores determined for 43.5% of tumors (70/161) were: 68.6% ≥50%, 8.6% 1%-49%, and 22.9% <1%. For the ICI ± ChT group, median PFS and OS were 4.6 months [95% confidence interval (CI) 2.1-8.2 months] and 20.6 months (95% CI 10.3-32.4 months), respectively. For ChT-alone recipients, median PFS and OS were 2.2 months (95% CI 2.0-3.0 months) and 6.8 months (95% CI 4.3-10.0 months), respectively. Applying a propensity score, ICI ± ChT was significantly associated with longer PFS (HR 0.46, 95% CI 0.29-0.72, P < 0.001) and longer OS (HR 0.46, 95% CI 0.28-0.74, P = 0.002) than ChT alone. According to this real-world analysis, first-line ICI ± ChT seems to have considerably improved the prognosis of APSCs. Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs). • First-line ICI ± ChT for advanced pulmonary sarcomatoid carcinoma (APSC) prolongs PFS and OS versus ChT alone. • KRAS and MET mutations are frequent in APSC. • ICI ± ChT appears to be a promising first-line therapy for APSC. BackgroundAmong the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs). Patients and methodsUsing the French Epidemiological Strategy and Medical Economics Lung Cancer (ESME-LC) database (2015-2022), we analyzed APSC patients’ first-line ICI ± ChT or ChT outcomes, then applied propensity score weighting to indirectly compare them. ResultsAmong 42 219 patients with untreated lung cancers, 229 (0.5%) had APSCs. One hundred and sixty-one (70.3%) received first-line treatment (43 ICI alone, 24 ICI + ChT, 94 ChT alone): median age, 66 years; 70.2% men; 69.8% Eastern Cooperative Oncology Group performance status 0/1, among 106 available values; 86.2% smokers or former smokers. Molecular testing was done for 113/161 (70.2%) patients, 35.4% of whom had a molecular abnormality, most frequently a KRAS mutation (39.7%). Programmed death-ligand 1 tumor proportion scores determined for 43.5% of tumors (70/161) were: 68.6% ≥50%, 8.6% 1%-49%, and 22.9% <1%. For the ICI ± ChT group, median PFS and OS were 4.6 months [95% confidence interval (CI) 2.1-8.2 months] and 20.6 months (95% CI 10.3-32.4 months), respectively. For ChT-alone recipients, median PFS and OS were 2.2 months (95% CI 2.0-3.0 months) and 6.8 months (95% CI 4.3-10.0 months), respectively. Applying a propensity score, ICI ± ChT was significantly associated with longer PFS (HR 0.46, 95% CI 0.29-0.72, P < 0.001) and longer OS (HR 0.46, 95% CI 0.28-0.74, P = 0.002) than ChT alone. ConclusionAccording to this real-world analysis, first-line ICI ± ChT seems to have considerably improved the prognosis of APSCs. Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs).BACKGROUNDAmong the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was undertaken to evaluate the efficacy [progression-free survival (PFS) and overall survival (OS)] of first-line immune checkpoint inhibitor (ICI) with or/without (±) chemotherapy (ChT) versus ChT alone against advanced PSCs (APSCs).Using the French Epidemiological Strategy and Medical Economics Lung Cancer (ESME-LC) database (2015-2022), we analyzed APSC patients' first-line ICI ± ChT or ChT outcomes, then applied propensity score weighting to indirectly compare them.PATIENTS AND METHODSUsing the French Epidemiological Strategy and Medical Economics Lung Cancer (ESME-LC) database (2015-2022), we analyzed APSC patients' first-line ICI ± ChT or ChT outcomes, then applied propensity score weighting to indirectly compare them.Among 42 219 patients with untreated lung cancers, 229 (0.5%) had APSCs. One hundred and sixty-one (70.3%) received first-line treatment (43 ICI alone, 24 ICI + ChT, 94 ChT alone): median age, 66 years; 70.2% men; 69.8% Eastern Cooperative Oncology Group performance status 0/1, among 106 available values; 86.2% smokers or former smokers. Molecular testing was done for 113/161 (70.2%) patients, 35.4% of whom had a molecular abnormality, most frequently a KRAS mutation (39.7%). Programmed death-ligand 1 tumor proportion scores determined for 43.5% of tumors (70/161) were: 68.6% ≥50%, 8.6% 1%-49%, and 22.9% <1%. For the ICI ± ChT group, median PFS and OS were 4.6 months [95% confidence interval (CI) 2.1-8.2 months] and 20.6 months (95% CI 10.3-32.4 months), respectively. For ChT-alone recipients, median PFS and OS were 2.2 months (95% CI 2.0-3.0 months) and 6.8 months (95% CI 4.3-10.0 months), respectively. Applying a propensity score, ICI ± ChT was significantly associated with longer PFS (HR 0.46, 95% CI 0.29-0.72, P < 0.001) and longer OS (HR 0.46, 95% CI 0.28-0.74, P = 0.002) than ChT alone.RESULTSAmong 42 219 patients with untreated lung cancers, 229 (0.5%) had APSCs. One hundred and sixty-one (70.3%) received first-line treatment (43 ICI alone, 24 ICI + ChT, 94 ChT alone): median age, 66 years; 70.2% men; 69.8% Eastern Cooperative Oncology Group performance status 0/1, among 106 available values; 86.2% smokers or former smokers. Molecular testing was done for 113/161 (70.2%) patients, 35.4% of whom had a molecular abnormality, most frequently a KRAS mutation (39.7%). Programmed death-ligand 1 tumor proportion scores determined for 43.5% of tumors (70/161) were: 68.6% ≥50%, 8.6% 1%-49%, and 22.9% <1%. For the ICI ± ChT group, median PFS and OS were 4.6 months [95% confidence interval (CI) 2.1-8.2 months] and 20.6 months (95% CI 10.3-32.4 months), respectively. For ChT-alone recipients, median PFS and OS were 2.2 months (95% CI 2.0-3.0 months) and 6.8 months (95% CI 4.3-10.0 months), respectively. Applying a propensity score, ICI ± ChT was significantly associated with longer PFS (HR 0.46, 95% CI 0.29-0.72, P < 0.001) and longer OS (HR 0.46, 95% CI 0.28-0.74, P = 0.002) than ChT alone.According to this real-world analysis, first-line ICI ± ChT seems to have considerably improved the prognosis of APSCs.CONCLUSIONAccording to this real-world analysis, first-line ICI ± ChT seems to have considerably improved the prognosis of APSCs. |
| ArticleNumber | 105343 |
| Author | Schneider, S. Bigot, F. Guisier, F. Chouaïd, C. Madroszyk, A. Ferrari, V. Girard, N. Lena, H. Dansin, E. Bizieux, A. Debieuvre, D. Quantin, X. Amrane, K. Cabarrou, B. Descourt, R. Falchero, L. Simoneau, Y. Bosquet, L. Justeau, G. Perol, M. |
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| Keywords | PD-L1 NSCLC pulmonary sarcomatoid carcinoma chemotherapy immunotherapy |
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| Snippet | Among the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study was... BackgroundAmong the aggressive non-small-cell lung carcinoma subtypes, pulmonary sarcomatoid carcinoma (PSC) is a rare and poorly understood tumor. This study... • First-line ICI ± ChT for advanced pulmonary sarcomatoid carcinoma (APSC) prolongs PFS and OS versus ChT alone. • KRAS and MET mutations are frequent in APSC.... |
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| SubjectTerms | Aged Cancer Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology chemotherapy Female France Humans Immune Checkpoint Inhibitors - therapeutic use immunotherapy Life Sciences Lung Neoplasms - drug therapy Lung Neoplasms - mortality Lung Neoplasms - pathology Male Middle Aged NSCLC Oncology Original PD-L1 pulmonary sarcomatoid carcinoma Treatment Outcome |
| Title | Efficacy of first-line treatments for advanced pulmonary sarcomatoid carcinomas: a real-world analysis |
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