- 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.
- 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.
- 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:
- 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).
- 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.
- Post-hoc analysis.