![]() ![]() “The dogma we held, that chemotherapy was 100% immunosuppressive, we now know is false. “We have learned a lot in…recent years about the association of chemotherapy with immunotherapy and the tumor microenvironment,” said Kelly during her presentation. Patients in the placebo arms of KEYNOTE-189 (n = 206) and KEYNOTE-407 (n = 281) crossed over to receive pembrolizumab after disease progression at rates of 41% and 32%, respectively.3,4 Survival data for those patients were inferior to that of those who received concurrent therapy, noted Kelly. 3,4 Combination therapy with pembrolizumab showed superior outcomes over placebo in both trials, with an overall survival (OS) rate at 12 months of 69.2% vs 49.4% (hazard ratio (HR), 0.49 95% CI, 0.38-0.64 P <.001) in KEYNOTE-189, and a median OS of 15.9 versus 11.3 months (HR for death, 0.64 95% CI, 0.49-0.85 P <.001) in KEYNOTE-407. ![]() She noted 2 relevant trials that studied concurrent versus sequential immunotherapy-KEYNOTE-189 (NCT02578680), which examined platinum chemotherapy plus pemetrexed with or without pembrolizumab (Keytruda), and KEYNOTE-407 (NCT02775435), which looked at carboplatin plus paclitaxel or nab-paclitaxel (Abraxane) chemotherapy with or without pembrolizumab. ![]() 1 “For a majority of our patients who do not have oncogenic-driven cancers, there is now overwhelming and compelling data for the role of immune checkpoint inhibitors, either with chemotherapy or as monotherapy in the first-line setting,” acknowledged Kelly. While the use of immune checkpoint inhibitors, as a monotherapy and in combination with chemotherapy, has demonstrated benefits for patients with NSCLC, the key to unlocking the full therapeutic potential for these treatments, said Kelly, an associate director for clinical research at the University of California Davis Comprehensive Cancer Center, lies in the timing of treatment initiation. At the 17th Annual Winter Lung Cancer Conference ®, hosted by Physicians’ Education Resource ®, LLC, presentations from Karen Kelly, MD and Gilberto de Lima Lopes, MD, looked for answers to address these issues. Although accumulating data continue to show immunotherapy as a major step forward in the treatment of patients with non–small cell lung cancer (NSCLC), questions regarding optimal sequencing and treatment duration still remain. ![]()
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