Pembrolizumab Versus Platinum-Based Chemotherapy in Advanced NSCLC
Posted: Tuesday, February 26, 2019
In patients with advanced non–small-cell lung cancer (NSCLC), pembrolizumab improved progression-free and overall survival compared with platinum-based chemotherapy, even when patients were allowed to cross over later from the chemotherapy arm to the pembrolizumab arm, according to an updated survival analysis of the KEYNOTE-024 trial. A team led by Martin Reck, MD, PhD, of the German Center of Lung Research, published these results in the Journal of Clinical Oncology.
“These results support pembrolizumab monotherapy as a standard-of-care regimen for first-line treatment of advanced NSCLC,” the authors wrote.
The randomized, open-label, phase III trial included 305 patients with previously untreated advanced NSCLC with a PD-L1 tumor proportion score of 50% or greater and without EGFR/ALKaberrations. Patients were randomly assigned to receive pembrolizumab every 3 weeks for up to 2 years (154 patients) or 4 to 6 cycles of the investigator’s choice of platinum-based chemotherapy (151 patients). Those who received chemotherapy could switch over to pembrolizumab later. The authors adjusted their overall survival and tolerability analyses for potential bias due to this patient crossover. The adjusted hazard ratio for overall survival for pembrolizumab vs chemotherapy was 0.49, when the authors adjusted for crossover.
The primary endpoint was progression-free survival, and the secondary endpoint was overall survival. The median follow-up was 25.2 months.
The median overall survival was 30 months with pembrolizumab and 14.2 months with chemotherapy. At the cutoff date of July 10, 2017, 73 patients in the pembrolizumab arm and 96 patients in the chemotherapy arm had died. A total of 82 patients initially treated with chemotherapy had crossed over to receive pembrolizumab.
In the trial, 31% of patients receiving pembrolizumab experienced grade 3 to 5 adverse events, compared with 53% of patients receiving chemotherapy.
Disclosure: The study authors’ disclosure information may be found at ascopubs.org.