ASCO 2018: First-Line Pembrolizumab Versus Chemotherapy in Advanced Lung Cancer
Posted: Monday, June 4, 2018
According to the findings of the KEYNOTE-042 trial, presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago (Abstract LBA4), the use of pembrolizumab demonstrated improved overall survival compared with platinum-based chemotherapy in patients with previously untreated, PD-L1–expressing advanced/metastatic non–small cell lung cancer (NSCLC). The study, conducted by Gilberto Lopes, MD, of the Sylvester Comprehensive Cancer Center and the University of Miami, and colleagues, reported this survival benefit with pembrolizumab in those who did not have sensitizing EGFR or ALK alterations and had a PD-L1 tumor proportion score (TPS) ≥ 1%.
“A large number of patients with lung cancer now have a new treatment option with better efficacy and fewer side effects than standard chemotherapy,” said Dr. Lopes in an ASCO press release. “Our study shows that pembrolizumab provides more benefit than chemotherapy for two-thirds of all people with the most common type of lung cancer.”
In this open-label, phase III study, Dr. Lopes and colleagues enrolled 1,274 patients. They received either pembrolizumab or investigator’s choice of paclitaxel plus carboplatin or pemetrexed plus carboplatin with optional pemetrexed maintenance. Of the patient population, about half had a TPS ≥ 50%, and nearly two-thirds had a TPS ≥ 20%.
After a median follow-up of 12.8 months, 13.7% and 4.9% of patients were still receiving pembrolizumab and pemetrexed maintenance, respectively. The team observed that pembrolizumab significantly improved overall survival in patients with a TPS ≥ 50% (hazard ratio, 0.69), ≥ 20% (hazard ratio, 0.77), and ≥ 1% (hazard ratio, 0.81). Median overall survival was longer with pembrolizumab than chemotherapy in those with a TPS ≥ 50% (20.0 vs. 12.2 months), a TPS ≥ 20% (17.7 vs. 13.0 months), and a TPS ≥ 1% (16.7 vs. 12.1 months). Fewer grade 3-5 drug-related adverse events were observed in the pembrolizumab cohort than the other cohorts (17.8% vs. 41.0%, respectively).
