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Pembrolizumab and Chemotherapy for Patients With EGFR- or ALK-Positive NSCLC

By: Cordi Craig, MS
Posted: Monday, November 1, 2021

Patients with recurrent EGFR- or ALK-positive non–small cell lung cancer (NSCLC) have limited treatment options other than additional therapy with targeted tyrosine kinase inhibitors. However, the results of a phase II prospective study suggested that the combination of pembrolizumab, carboplatin, and pemetrexed may provide durable responses for patients with EGFR-mutated or ALK-rearranged NSCLC. Shirish M. Gadgeel, MD, of the Henry Ford Cancer Institute, Detroit, and colleagues concluded that the data warrant further study of pembrolizumab and chemotherapy among patients with EGFR-mutated NSCLC. The research was presented during the International Association for the Study of Lung Cancer (IASLC) 2021 World Conference on Lung Cancer (Abstract OA09.03).

To analyze response and survival results, the researchers enrolled 33 patients with recurrent EGFR-mutated (n = 26) or ALK-rearranged (n = 7) NSCLC. The patients received carboplatin, pemetrexed, and pembrolizumab every 3 weeks for 4 cycles, followed by maintenance therapy with pemetrexed and pembrolizumab for up to 2 years.

Patients with EGFR-mutated NSCLC achieved a response rate of 42%, compared with 29% among patients with ALK-rearranged NSCLC. Among all patients, the median duration of response was 6.1 months. The median progression-free survival was 8.3 months versus 2.9 months in patients with EGFR-mutant and ALK-rearranged disease, respectively. Patients with EGFR-mutated disease achieved a median overall survival of 22.2 months versus 2.9 months in patients with ALK-rearranged NSCLC.

Fatigue, nausea, cytopenia, cough, and dyspnea were the most commonly reported adverse events with the investigation combination theapy. The most common severe adverse events included neutropenia, thrombocytopenia, thromboembolism, and elevated ratio between the concentrations of aspartate transaminase and alanine transaminase. A single patient developed pneumonitis.

Disclosure: For full disclosures of the study authors, visit library.iaslc.org.



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