In a nutshell
This study investigated the effect of pembrolizumab (Keytruda) in non-small cell lung cancer (NSCLC).
They found that this treatment was effective as a first-line therapy for NSCLC.
Some background
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Patients with advanced NSCLC are usually treated with standard chemotherapy (CT). This gives an average survival of 12 months. CT is also associated with many side effects. Targeted therapies may be more effective at prolonging survival.
Immune checkpoint inhibitors (ICIs) are a new type of cancer drug. Pembrolizumab (PEM) is a drug that blocks the PD-1 receptor. This receptor Is activated by a protein called PD-L1. Blocking this pathway allows the immune system to recognize and kill cancer cells. PEM has been used in advanced cancers with no other treatment options. PEM prolonged survival in some of these trials. It is unclear if PEM improves survival when administered as a first-line therapy in patients with advanced NSCLC.
Methods & findings
This study included 1274 patients with NSCLC. Patients were randomly assigned to receive either PEM (637 patients) or CT (637). PEM was administered every 3 weeks intravenously (200 mg dose). The average follow-up time was 12.8 months. Patients were categorized based on tumor proportion score (TPS). TPS is the percentage of tumor cells expressing the PD-L1 protein. TPS categories were 50% or higher (TPS50+), 20% or higher (TPS20+) and 1% or higher (TPS1+).
Overall survival was significantly longer in PEM-treated patients compared to CT. TPS50+ patients survived an average of 20 months compared to 12.2 months in CT patients. TPS20+ survived an average 17.7 months with PEM compared to 13 months with CT. TPS1+ patients survived an average 16.7 months compared to 12.1 months in CT patients.
63% of PEM patients experienced side effects. 90% of patients in the CT group experienced side effects. The most common side effects were low thyroid hormone levels (PEM) and anemia (CT). The death rate from serious side effects was 2% in both groups.
The bottom line
The authors concluded that pembrolizumab was effective as a first-line therapy for advanced NSCLC.
The fine print
This study was open label. This means that both the doctor and patients knew what treatment they were getting.
What’s next?
If you have any concerns regarding lung cancer treatment, please consult with your oncologist.
Published By :
Lancet (London, England)
Date :
Apr 04, 2019
