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ESMO 2020 | KEYNOTE-024 update: pembrolizumab vs platinum-based chemotherapy in NSCLC

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Martin Reck

Martin Reck, MD, PhD, German Center of Lung Research, Grosshansdorf, Germany, discusses the KEYNOTE-024 trial, involving pembrolizumab compared to platinum-based chemotherapies in participants with metastatic non-small cell lung cancer (NSCLC). The study saw substantial improvement of overall survival (OS) favoring pembrolizumab, with the 5-year survival rate doubling and a 5-year OS rate of 31.9%. Professor Reck explains that there was an opportunity for patients who experienced disease progression after benefitting from pembrolizumab to receive a second course of treatment, with an overall response rate of 33% and stabilization of 50%. This interview was recorded via an online conference call with The Video Journal of Oncology (VJOncology).

Transcript (edited for clarity)

I think chemo 24 was one of the first trials investigating a monotherapy with a checkpoint inhibitor as a potential first-line treatment for our patients with advanced non-small cell lung cancer. And this has been investigated in a special population of patients with a high PD-L1 expression on the tumor cells and four years ago, we presented the first resides at the meeting in Copenhagen...

I think chemo 24 was one of the first trials investigating a monotherapy with a checkpoint inhibitor as a potential first-line treatment for our patients with advanced non-small cell lung cancer. And this has been investigated in a special population of patients with a high PD-L1 expression on the tumor cells and four years ago, we presented the first resides at the meeting in Copenhagen. And this was really a great meeting.

We were able to show a significant improvement in progression in free survival, which was our primary endpoint and also an overall survival favoring the monotherapy with pembrolizumab compared to platinum-based chemotherapy together was a favorable tolerability profile.

Now, we followed up the patients and what we have seen in the control arm or the most opportunity to cross out the pembrolizumab. We have observed meanwhile, a crossover rate of 66%.

However, despite this crossover rate, we still do see a substantial improvement in overall survival favoring the monotherapy with pembrolizumab. Now we are reporting the five years survival rates for this treatment. We do see nearly a doubling of the five-year survival rates, favoring the monotherapy with a five-year overall survival rate of 31.9%.

And I think this is really an amazing signal for a monotherapy, which is a completely new treatment option for patients with advanced lung cancer.

Besides that we have seen a consistency in a favorable tolerability for the patients who have been treated with the monotherapy, and we have made another interesting observation.

So in the keynote 24 trial, patients were receiving two years of pembrolizumab. Then, the protocol treatment was stopped and the patients were followed up. And what we did observe was a stabilization of the disease in a couple of patients, sometimes four months, sometimes even four years, and per protocol, there was the opportunity for a second cause a re-exposition to pembrolizumab in the situation that the patient did progress.

And currently we also do have the first data for those patients who received the second cause of pembrolizumab after follow up, after the first two years of pembrolizumab. And again, we do observe a response rate of 33% and we do observe a stabilization of disease of 50%. So in that group of patients who already benefited from this first-line therapy, there is also the chance for a re-exposition. And I think this is great information, a great message for patients with lung cancer.

 

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