In this podcast, Dr Elene Mariamidze (a member of the ESMO Young Oncologists Committee and the Georgian Group of Young Oncologists) interviews Dr Laura Mezquita (Thoracic Oncology Group) regarding novelties presented in ESMO 2020 in the field of metastatic non-small-cell lung cancer (NSCLC).
Keynote-024 5-year overall survival (OS) update: first line Pembrolizumab versus platinum based chemotherapy in patients with metastatic NSCLC and programmed death-ligand 1 (PD-L1) tumor proportion score ≥50%.
This is one of the first trials to present 5-year OS in a metastatic subgroup of patients using IO. OS was 31.9% versus 16.3% in the Pembrolizumab and chemotherapy groups, respectively, with overall responce rate (ORR) at 3 years of 82% for Pembrolizumab. Patients were exposed to 2 years (35 cycles) of Pembrolizumab treatment in the experimental arm. The crossover rate from chemotherapy to Pembrolizumab upon progression was 66%. Long-term treatment with Pembrolizumab did not identify new safety signals. Incidence of any-grade and grade 3-5 treatment-related adverse events was lower in Pembrolizumab versus chemotherapy groups. The retreatment group that was re-exposed to Pembrolizumab for the second course (12 patients) had 33% ORR—this opens a new niche for reinitiating IO in future trials and eventually maybe daily clinical practice—though the data is not mature yet1.
In the era of the COVID-19 pandemic, exposure to a 6-weekly instead of 3-weekly regimen of Pembrolizumab fixed dose is a sound option.
The fact that even in this selected population of PD-L1 ≥50% tumor, a subset of patients still progressed on immunotherapy underlines the importance of identifying new biomarkers to help us choose the best options of therapy in the future.
Acknowledgments
Funding
None declared.
Disclosure
The authors have declared no conflicts of interest.
Appendix
Reference
- 1.Brahmer J.R. KEYNOTE-024 5-year OS update: First-line (1L) pembroliz umab (pembro) vs platinum-based chemotherapy (chemo) in patients (pts) with metastatic NSCLC and PD-L1 tumour proportion score (TPS) ≥50% Annals of Oncology. 2020:S1181–S1182. [Google Scholar]
Further reading
- 2.Brahmer J., Rodríguez-Abreu D., Robinson A.G. OA 17.06 Updated analysis of KEYNOTE-024: pembrolizumab vs platinum-based chemotherapy for advanced NSCLC with PD-L1 TPS ≥50% J Thorac Oncol. 2017;12(suppl 2):S1793–S1794. [Google Scholar]
- 3.Reck M., Rodríguez-Abreu D., Robinson A.G. Pembrolizumab versus chemotherapy for PD-L1–positive non–small-cell lung cancer. N Engl J Med. 2016;375:1823–1833. doi: 10.1056/NEJMoa1606774. [DOI] [PubMed] [Google Scholar]
- 4.Reck M., Rodríguez-Abreu D., Robinson A.G. Updated analysis of KEYNOTE-024: pembrolizumab versus platinum-based chemotherapy for advanced non-small-cell lung cancer with PD-L1 tumor proportion score of 50% or greater. J Clin Oncol. 2019;37:537–546. doi: 10.1200/JCO.18.00149. [DOI] [PubMed] [Google Scholar]
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