Dr. Spigel on Pembrolizumab/Chemo Combo in First-Line NSCLC

David Spigel, MD, chief scientific officer, director, Lung Cancer Research Program, principal investigator, Sarah Cannon Research Institute, discusses the results of cohort G from the KEYNOTE-021 trial, which explored pembrolizumab (Keytruda) combined with pemetrexed/carboplatin as a frontline treatment for patients with metastatic or advanced nonsquamous non—small cell lung cancer (NSCLC).

Pembrolizumab was approved as a first-line treatment for both squamous and nonsquamous histologies and in patients with high PD-L1 expression, which makes up approximately 25% of the patient population, Spigel explains. However, the KEYNOTE-021 trial revolved around the debate of whether the combination of immunotherapy and chemotherapy has the potential to be the new frontline standard of care.

In this phase II trial, patients were randomized to receive the triplet versus chemotherapy alone. It was designed to explore progression-free and overall survival, regardless of PD-L1 expression, he adds. Results showed that there was a significant improvement in response rate and progression-free survival in patients who received the combination regimen; however, there was no OS advantage.