I squam, you squam.

Targeted Therapy: Pembrolizumab, a PD-1-targeted monoclonal antibody.
The Trial: The benefit of adding pembro to chemo has already been established in adenocarcinoma non-small cell lung cancer (NSCLC) regardless of PD-L1 expression. Now it's squam's turn. The phase 3 KEYNOTE-407 trial randomized 559 patients with newly diagnosed metastatic squamous cell NSCLC to carboplatin with a taxane q3 weeks x 4 cycles +/- pembrolizumab 200 mg q3 weeks x 35 cycles (i.e., >2 years). Enrollees were pretty evenly divided into three cohorts by tumor PD-L1 expression: [1] <1%, [2] 1-49% and [3] ≥50%. Differences in rates of overall survival at one year without → with the addition of pembro were: [1] 43 → 64%, [2] 50 → 66%, and [3] 51 → 63%.
The Takeaway: The addition of pembro to chemo prolongs overall survival in patients with metastatic squamous cell NSCLC, regardless of PD-L1 expression. Whether or not they need the chemo remains unclear until someone finally publishes KEYNOTE-042. | Paz-Ares, N ENgl J Med 2018


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