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Adding pembrolizumab to standard chemotherapy roughly halved the risk of death in newly diagnosed non-squamous lung cancer, whatever the PD-L1 level, making chemo-immunotherapy the default first treatment.
Double-blind phase 3 trial of 616 patients with untreated metastatic non-squamous NSCLC without EGFR or ALK alterations, randomised 2:1 to pembrolizumab or placebo plus pemetrexed and a platinum. Primary endpoints were overall survival and PFS.
12-month overall survival was 69.2% vs 49.4% (HR 0.49) and median PFS 8.8 vs 4.9 months (HR 0.52), with benefit in every PD-L1 stratum including below 1%. Together with KEYNOTE-024 (pembrolizumab alone for PD-L1 of 50% or more) it made PD-1 blockade part of first-line treatment for almost all patients with advanced NSCLC. The five-year update showed OS 19.4% vs 11.3%.
Most patients with newly diagnosed advanced non-squamous lung cancer that lacks a targetable mutation should receive chemotherapy plus pembrolizumab; those with PD-L1 of 50% or more may reasonably receive pembrolizumab alone. About one in five patients is alive at five years, compared with roughly one in ten with chemotherapy alone. Patients with EGFR or ALK alterations were excluded and should have targeted therapy first.
Shares Make six-weekly immunotherapy the default schedule, Restore weight-based dosing and vial sharing for immunotherapy in the label, A single calibrated tumour mutational burden across all sequencing panels, Immune-related adverse events (irAEs).
Shares Make six-weekly immunotherapy the default schedule, Restore weight-based dosing and vial sharing for immunotherapy in the label, Give subcutaneous immunotherapy in community clinics and at home, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch.
Shares Immune-related adverse events (irAEs), Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Progression-free survival (PFS), Overall survival (OS).
Shares Lines of therapy, Progression-free survival (PFS), Overall survival (OS), No one can predict who responds to immunotherapy.
Shares Lines of therapy, PD-L1-high non-small-cell lung cancer without a driver mutation, Progression-free survival (PFS), Overall survival (OS).
Shares Lines of therapy, Progression-free survival (PFS), Overall survival (OS), No one can predict who responds to immunotherapy.
Shares Lines of therapy, Progression-free survival (PFS), Overall survival (OS), No one can predict who responds to immunotherapy.
Shares PD-L1-high non-small-cell lung cancer without a driver mutation, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Progression-free survival (PFS), Overall survival (OS).