Pembrolizumab in first-line therapy improves survival independent of PD-L1 expression and brain metastases in patients with NSCLC

Best Practice Nordic | Jun 2020 | ASCO20 Virtual |

The 3 KEYNOTE-189 study has compared pembrolizumab, plus pemetrexed and platinum versus placebo plus pemetrexed-platinum as first-line therapy in patients with metastatic, non-squamous, non-small cell lung cancer without sensitizing EGFR of ALK mutation, regardless of PD-L1 aspiration. The final analysis of the study was presented at this year’s ASCO20 congress by Delvys Rodriguez-Abreu, medical oncologist from the University Insular Hospital in Canary Island, Spain. The study has shown that pembrolizumab in combination with chemotherapy significantly improves overall survival (OS) and progression-free survival (PFS) compared to placebo in combination with chemotherapy. The patients were randomized (2:1) and treated with pemetrexed and platinum plus pembrolizumab (n = 410) or placebo (n = 206) every 3 weeks for 4 cycles, then maintenance pemetrexed plus pembrolizumab or placebo for up to a total of 35 bicycles. Patients with disease progression in the placebo combination group then switched to treatment with pembrolizumab monotherapy. The primary endpoints were OS and PFS. Secondary endpoint was ORR. PFS2 corresponding to time from randomization to objective tumor progression on 2nd line therapy was an explorative endpoint. Results from the treatment with pembrolizumab in combination with chemo achieved higher OS (22.0 vs 10.6) and higher PFS (9.0 vs 4.9) compared to the control group. The two-year OS rate was 45.7% in the pembrolizumab group compared to 27.3% in the placebo group. After two years, the PFS rate was 22.0 in the pembrolizumab group and 3.4% in the control group. ORR was 48.3% in the group of patients treated with pembrolizumab in combination with chemotherapy, compared with 19.9% ​​in the control group. The authors conclude that data from the study support first-line therapy with pembrolizumab in combination with chemotherapy for patients with previously untreated metastatic non-small cell lung cancer. Read abstract published on Asco here