Dr. VanderWalde on the Clinical Implications of IMpower150 and KEYNOTE-021

Ari VanderWalde, MD, MPH, director, West Cancer Center, assistant professor, Division of Hematology/Oncology, the University of Tennessee Health Science Center, discusses the design of the IMpower150 and KEYNOTE-021 trials.

IMpower150 was a large, randomized trial of 1200 patients with non—small cell lung cancer (NSCLC) who received atezolizumab (Tecentriq) plus carboplatin and paclitaxel, with bevacizumab plus carboplatin and paclitaxel, or bevacizumab plus carboplatin and paclitaxel. The atezolizumab arm was superior to bevacizumab, carboplatin, and paclitaxel alone. Additionally, cohort G of the phase II study KEYNOTE-021 trial enrolled 120 patients with NSCLC. Patients were randomized to pembrolizumab (Keytruda) with carboplatin and pemetrexed or carboplatin and pemetrexed alone. The combination was superior to the combination chemotherapy.

However, during the course of these trials, frontline treatment became segmented based on PD-L1 status. Now, the standard of care is single-agent pembrolizumab for patients with high PD-L1 expression. Physicians should therefore interpret the results with caution, says VanderWalde.