Dr. Ramalingam on Pembrolizumab and Chemotherapy in NSCLC

Suresh A. Ramalingam, MD, deputy director of Winship Cancer Institute of Emory University, discusses data with pembrolizumab (Keytruda) and chemotherapy in patients with non—small cell lung cancer (NSCLC).

Cohort G of the KEYNOTE-21 trial, which was a randomized phase II study, showed that adding pembrolizumab to chemotherapy in patients with nonsquamous disease was associated with an improved progression-free survival, high response rates, and a trend toward improved survival. That appears to be confirmed by the KEYNOTE-189 study, explains Ramalingam.

This brings the combination approach of chemotherapy plus immunotherapy to the forefront. Physicians no longer look at all patients with nonsquamous lung cancer as one group in the context of immunotherapy. Ramalingam believes it is important to think about patients who have a high PD-L1 expression of 50%.

Positive data with patients with PD-L1 expression greater than 50% has suggested that pembrolizumab monotherapy is superior to chemotherapy alone, as it has demonstrated a median overall survival of approximately 30 months. Whether chemotherapy plus pembrolizumab is going to be better than pembrolizumab alone is still unknown, says Ramalingam.