Dr. Herbst on Key Immunotherapy Findings in NSCLC

Roy S. Herbst, MD, PhD, professor of Medicine, chief of Medical Oncology, Yale Cancer Center and Smilow Cancer Hospital, chair of the SITC Cancer Immunotherapy Guidelines NSCLC Subcommittee, discusses key immunotherapy findings in non—small cell lung cancer, presented at the 2018 ASCO Annual Meeting.

Data presented at the 2018 ASCO Annual Meeting, though somewhat incremental, were practice-changing, explains Herbst. Data were presented on the KEYNOTE-042 and KEYNOTE-407 trials. KEYNOTE-042 looked at the use of pembrolizumab (Keytruda) monotherapy versus chemotherapy in patients with ³1% PD-L1 expression. The trial was positive with a reported hazard ratio (HR) of 0.81 across patient subgroups. That means that patients are better off getting immunotherapy versus chemotherapy, Herbst says.

However, Herbst explains that further investigation into the group with high PD-L1 expression revealed that the HR was 0.69. Whereas, the group with low PD-L1 expression reflected a HR of 0.92. Therefore, most of the benefit was driven by the patients with high PD-L1 expression. The trial serves as an endorsement for the use of immunotherapy in these patients, but Herbst says that he might consider giving a combination.

Also presented at the 2018 ASCO Annual Meeting was the KEYNOTE-407 trial in squamous cell carcinoma. That trial looked at the use of frontline carboplatin and paclitaxel or nab-paclitaxel (Abraxane) with or without pembrolizumab across all PD-L1 expressers. The HR was 0.64. The same holds true for patients with nonsquamous carcinoma, based on the results of the KEYNOTE-189 trial. This leaves physicians to believe that combination chemotherapy and immunotherapy will be the predominant treatment moving forward, Herbst says.