AACR 2019—Pembrolizumab/chemo boosts survival in NSCLC with brain/liver metastases


  • Keren Landman, MD
  • Univadis
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Takeaway

  • Adding pembrolizumab to pemetrexed-platinum chemotherapy improved PFS and OS in patients with NSCLC metastases to the liver and brain.

Why this matters

  • Prognosis for patients with metastatic nonsquamous NSCLC is historically poor.

Study design

  • Post-hoc analysis of data for patients with untreated NSCLC and liver/brain metastases enrolled in KEYNOTE-189, a phase 3, 2:1 randomized, placebo-controlled trial of pemetrexed-platinum with/without pembrolizumab.
  • Randomization was stratified by programmed death-ligand 1 tumor proportion score, platinum (carboplatin vs cisplatin), and smoking status.
  • Patients were Eastern Cooperative Oncology Group PS 0/1 and without EGFR/ALK alteration.
  • Funding: MSD.

Key results

  • 19% of patients had liver metastases and 18% had brain metastases.
  • Median follow-up duration was 18.7 months.
  • Patients with both liver and brain metastases receiving pembrolizumab vs placebo had higher:
    • PFS:
      • Liver: 6.1 (95% CI, 4.7-8.5) vs 3.4 (95% CI, 2.8-4.7).
      • Brain: 6.9 (95% CI, 5.4-11.0) vs 4.7 (95% CI, 2.2-5.5). 
    • OS:
      • Liver: 12.6 (95% CI, 8.1-19.1) vs 6.6 (95% CI, 4.6-7.6).
      • Brain: 19.2 (95% CI, 15.0-25.9)  vs 7.5 (95% CI, 4.6-10.0).
  • Risk of death and/or progression was reduced by approximately half irrespective of the presence or absence of liver or brain metastases.

Limitations

  • Post-hoc analysis.