Promising data for patients with inoperable, locally advanced stage III non-small cell lung cancer

Best Practice Nordic | Jun 2020 | ASCO20 Virtual |

Non-small-cell lung cancer (NSCLC) stage III patients are inoperable and are offered chemotherapy or radiation therapy if the patient's performance status allows it. However, no reduction in relapse is achieved, and the five-year survival rate of this treatment is low. The anti-PD-L1 checkpoint inhibitor pembrolizumab has shown long-term clinical efficacy as first-line treatment in metastatic non-small cell lung cancer, as monotherapy for PD-L1-positive tumors and in combination with chemotherapy regardless of PD-L1 status. These clinical data are the background of the KEYNOTE 799 study, where the efficiency and safety of pembrolizumab therapy as first-line therapy in combination with chemotherapy and radiotherapy for patients with locally advanced stage III non-small cell lung cancer was investigated. The results of the KEYNOTE-799 study was presented at this year’s ASCO20 congress. KEYNOTE 799 is a non-randomized, open-label phase II trial of patients with previously untreated, inoperable, pathologically confirmed stage IIIA-C non-small cell lung cancer. Data was assessed from RECIST 1.1. Patients were treated with 17 cycles of pembrolizumab 200 mg Q3W combined with thoracic radiotherapy in cycles 2 and 3. For cycle 1, the treating physician could choose paclitaxel 200 mg / m2 + carboplatin AUC 6 Q3W. Thereafter, paclitaxel 45 mg / m2 + carboplatin AUC 2 QW for cycle 2-3 (cohort A) or cisplatin 75 mg / m2 + pemetrexed 500 mg / m2 Q3W (for patients with non-planocellular carcinoma) in cycle 1-3 (cohort B). The median follow-up time was 8.3 months for cohort A and 5.8 for cohort B. Objective response rate, ORR (90% CI) was 67% for cohort A and 56.6% for cohort B. The study shows that 9 patients in cohort A corresponding to 8.0% and 4 patients in cohort B corresponding to 5.5% developed grade ≥3 pneumonitis. Treatment-related side effects value ≥3 occurred in 72 patients (64.3%) in...