Raise a Pimm’s for pem.

Top Line: The landmark publication of KEYNOTE-024 in 2016 reported an overall survival advantage with the PD-1 inhibitor pembrolizumab in lieu of platinum-based chemo as first-line treatment for metastatic non-small cell lung cancer (NSCLC) with PD-L1 expression of at least 50%.
The Study: This was huge, as few previous studies had the gumption to randomize patients with advanced lung cancer to receive no chemo whatsoever. But the superiority of pembro was clear. So clear, in fact, that the trial was stopped early at second interim analysis after only one-third of enrollees had died due to the ethical imperative to offer pembro crossover to the chemo arm. After more than two years (clear foreshadowing here), we finally have the median survival times. Hold on to your hats, ladies and gents. Up-front platinum-based chemo was in line with historical trials with affording 14 months. Pembro, on the other hand, was way out of line with achieving an unheard of 30 months (!) among these pretty much all-comers with metastatic lung cancer. Caveat being that they all came without ALK- or EGFR-aberrations and, again, with PD-L1 expression of ≥50%. And this survival gap is despite the aforementioned early-crossover to pembro by over half the patients randomized to chemo.
Bottom Line: Pembro monotherapy for metastatic NSCLC with ≥50% expression of PD-L1 results in almost unprecedented survival times, and we say “almost” because...SBRT. | Reck, J Clin Oncol 2019


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