Good rationale.

Top Line: Recent advancements in systemic treatment of non-small cell lung cancer (NSCLC) are astounding, but the squamous cell variety has been somewhat left behind.

The Study: In stark contrast to the remarkably nuanced genomic approaches to individualized treatment of adenocarcinoma, there is currently no personalized medicine algorithm for squamous cell carcinoma (SCC). As a reminder, the current standard for stage IV SCC is chemo + pembrolizumab, regardless of PDL-1 status, as it is currently the only immune checkpoint inhibitor to demonstrate an improvement in overall survival in a population of only squams. Now on deck is the PDL-1 inhibitor tislelizumab, specifically engineered to minimize Fcγ receptor binding on macrophages that is a common mechanism for resistance. In RATIONALE-307, 355 Chinese patients receiving chemotherapy for advanced squamous cell NSCLC were randomized to chemo +/- the addition of tislelizumab. Of note, roughly two-thirds had stage IV disease with the remaining one-third having stage IIIB, which leaves us unclear why the latter wasn’t treated with curative intent chemoradiation. Nonetheless the primary endpoint of progression-free survival was significantly improved with the addition of tislelizumab (5.5→ 7.6 months). Notwithstanding final results of the still immature overall survival data, the associated commentary points out this at least adds some competition to an exorbitantly priced market.

TBL: Like other immune checkpoint inhibitors before it, tislelizumab improves progression-free survival when added to chemotherapy for squamous cell NSCLC. | Wang, JAMA Oncol 2021


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