Pembrolizumab, plus chemotherapy improves survival and newly diagnosed metastatic non-small cell lung cancer
In the KEYNOTE-189 study, the addition of immunotherapy to Pemtrexed and a platinum agent in the first-line setting was superior to chemotherapy alone.OS was improved by 51%. 616 patients enrolled who had untreated stage IV nonsquamous NSCLC and no driver mutations such as EGFR or ALK. Patients were stratified by PD-L1 expression and were randomized in a 2:1 fashion to receive treatment with four cycles of pembrolizumab/ pemetrexed/carboplatin vs placebo plus chemotherapy. In the placebo arm, patients received pemetrexed maintenance and were allowed to cross over to immunotherapy arm at progression. There was a significant benefit in overall survival when pembrolizumab was added to chemotherapy. Median overall survival was not yet reached in the experimental arm vs 11.3 months in the control arm. At 12 months, 69.2% of patients were alive in the experimental arm vs 49.4% of the control arm. The addition of pembrolizumab achieved a 51% increase in overall survival (P < .00001). All subgroups benefited from the addition of pembrolizumab, but the greatest benefit was in the group expressing high levels of PD-L1 (tumor proportion score ≥ 50%).
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