Frontline pembrolizumab+chemotherapy best for advanced NSCLC

  • Yu Y & al.
  • JAMA Netw Open
  • 3 Jul 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Immunotherapies, including immune checkpoint inhibitors (ICIs), tumor vaccines, and cellular immunotherapy, were associated with better OS and PFS compared with conventional therapy for advanced NSCLC.

Why this matters

  • Pembrolizumab with platinum-based chemotherapy was the most effective ICI regimen and should be used as first-line treatment. PD-L1 expression and tumor mutation burden (TMB) should be used as predictors for survival and objective response rate (ORR).

Study design

  • Meta-analysis of 31 randomized clinical trials of immunotherapy for advanced NSCLC with 14,395 patients and an individual patient-level analysis of 1833 patients.
  • Funding: National Natural Science Foundation of China; others.

Key results

  • Compared with conventional therapy, immunotherapy was associated with significantly better OS (HR, 0.76; P<.001 and pfs p>
  • Immunotherapy yielded a higher ORR than conventional therapy (risk ratio, 1.33; P<.001 with a significant objective response benefit icis ratio p>
  • First-line pembrolizumab with platinum-based chemotherapy was superior to other ICI regimens.
  • TMB plus PD-L1 expression was better at predicting PFS, ORR, or durable clinical benefit (DCB) compared with TMB or PD-L1 expression alone (1-year PFS: area under the curve [AUC], 0.829; 3-year PFS: AUC, 0.839; ORR: AUC, 0.803; DCB: AUC, 0.740).

Limitations

  • Limited data for some subgroup analyses.

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