OBR OncologyDo New Data “Slam the Door” on Immunotherapy After NSCLC Progression?

A panel of experts discussed the implications of recent findings and debated the future role of immunotherapy in this patient population.

The phase 3 KEYNOTE-789 study, presented at the 2023 American Society of Clinical Oncology annual meeting, revealed that adding pembrolizumab to chemotherapy did not significantly improve outcomes in patients with stage IV EGFR-mutated non-small cell lung cancer (NSCLC) who had progressed after tyrosine-kinase inhibitor treatment.

Key Points:

• The KEYNOTE-789 study involved 492 patients with confirmed stage IV NSCLC, who were randomly assigned to receive pembrolizumab plus platinum-based chemotherapy for two years or placebo and platinum-based chemotherapy.
• The median progression-free survival (PFS) was 5.6 months in the pembrolizumab group versus 5.5 months in the placebo plus chemotherapy group, a non-statistically significant difference.
• The median overall survival in the pembrolizumab group was 15.9 months versus 14.7 months in the placebo group, again not statistically significant.
• The overall response rate in the pembrolizumab group was 29% versus 27% in the placebo group.

Additional Points:

• The study found that grade 3 or higher toxicities were slightly higher in the group that received pembrolizumab.
• About 20% of the patients had central nervous system (CNS) progression at the time of enrollment.
• The panelists agreed that the study does not completely rule out the potential role of immunotherapy, especially in combination with anti-angiogenic therapy.

Conclusion:

• Although the KEYNOTE-789 study did not demonstrate a significant benefit of adding pembrolizumab to chemotherapy in this patient population, the panelists agreed that the door should not be completely closed on the potential role of immunotherapy, especially in combination with anti-angiogenic therapy.

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