Dr. Kim on the KEYNOTE-189 Trial in Metastatic NSCLC

Edward S. Kim, MD, chair, Department of Solid Tumor Oncology, Levine Cancer Institute, discusses the randomized, double-blind, phase III KEYNOTE-189 trial inpatients with previously untreated, metastatic nonsquamous non—small cell lung cancer (NSCLC).

In the trial, patients with stage IV nonsquamous disease were randomized 2:1 to plus pemetrexed and investigator’s choice of cisplatin or carboplatin plus either pembrolizumab (Keytruda) or placebo, followed by pemetrexed maintenance with pembrolizumab or placebo. The addition of pembrolizumab showed a clear benefit in OS compared with chemotherapy alone. At 12 months, the overall survival (OS) rate in patients treated with chemotherapy plus pembrolizumab was 69.2% compared with 49.4% in those treated with chemotherapy alone (HR for death, 0.49; 95% CI, 0.38 to 0.64; P <.001).

The trial completely changed the treatment paradigm, says Kim, and the combination regimen is now the frontline standard of care for nonsquamous NSCLC, regardless of PD-L1 status.

In the past, treatment with chemotherapy left patients severely fatigued and the agents were not as effective, reflects Kim. Now, chemotherapy agents such as pemetrexed are well-tolerated and easy to combine with other agents. Furthermore, the addition of an immunomodulatory agent for maintenance treatment can potentially result in a durable response once treatment is stopped, concludes Kim.