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Chemoradiotherapy Plus Pembrolizumab for Stage III Lung Cancer

By: Joshua Swore
Posted: Wednesday, May 20, 2020

Combined treatment of pembrolizumab and chemoradiotherapy for patients with stage III non–small cell lung cancer (NSCLC) appears to be safe and tolerable, according to a phase I trial published in JAMA Oncology. “First-line therapy with programmed cell death 1 inhibition and chemoradiotherapy for stage III non–small cell lung cancer…should continue to be evaluated in phase II and III clinical trials,” reported Salma K. Jabbour, MD, of Rutgers Cancer Institute, New Jersey, and colleagues.

The study analysis included 21 patients with NSCLC who received one or more cycles of pembrolizumab. A total of 20 patients received a 60-Gy radiotherapy regimen and a median of seven cycles of pembrolizumab. Chemotherapy , which included carboplatin and paclitaxel, was received by 15 of the 21 patients. The median follow-up was 16 months.

The authors observed a median progression-free survival of 18.7 months (range, 11.8–29.4 months) in patients who had received at least one dose of pembrolizumab. The 6-month and 12-month progression-free survival rates were 81% (95% confidence interval [CI], = 64.1%–97.7%) and 69.7% (95% CI = 49.3%–90.2%), respectively. The outlook improved when patients received two or more doses of pembrolizumab, as the progression-free survival median rose to 21 months, with 6-month and 12-month progression-free survival rates of 84.5% (95% CI = 67.8%–100%) and 78.2% (95% CI = 59.2%–97.2%), respectively.

Overall, the rate of grade 2 events or higher was 67%, and there were no cases of dose-limiting adverse events. The authors noted that pneumonitis of grade 2 or higher occurred in 33% of patients, with one patient recording grade 5 pneumonitis. Other immune-related adverse events included interstitial nephritis, type 1 diabetes, and hyperthyroidism. 

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.



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