Non-small cell lung cancer (NSCLC) has traditionally had a poor prognosis in terms of overall survival. This dismal outcome is changing, however: the phase 1 KEYNOTE-001 study found that pembrolizumab (Keytruda®, Merck) substantially increases five-year overall survival for patients with advanced NSCLC. In this interview with i3 Health, Edward B. Garon, MD, the study's lead investigator, discusses the trial's results and their implications for patients and physicians.
Can you comment on the significance of your results concerning five-year overall survival for pembrolizumab in advanced NSCLC?
Edward B. Garon, MD: While patients with advanced NSCLC were previously felt to have a uniformly poor outcome, we now know that a meaningful percentage of patients can be alive at five years, particularly among patients with programmed death-ligand 1 (PD-L1) expression in at least half of their tumor cells.
How does pembrolizumab compare with other treatments for advanced NSCLC?
Dr. Garon: Pembrolizumab is similar to other programmed cell death protein 1 (PD-1) and PD-L1 inhibitors, but one thing that is unique about pembrolizumab is that it is approved as monotherapy in treatment-naive patients with PD-L1 expression in the tumor.
How do you see the treatment of advanced NSCLC evolving?
Dr. Garon: It is always difficult to know what will come, but in patients with PD-L1 less than 50%, combinations of chemotherapy and immunotherapy appear to be a superior approach compared with single-agent immunotherapy.
Do you have any words of advice for community oncologists treating patients with advanced NSCLC?
Dr. Garon: Things have clearly gotten better over time for these patients. I would like to see oncologists in the community have a more positive outlook on patients with metastatic NSCLC. The anticipated outcome is better than it was just a few years ago.
About Dr. Garon
Edward B. Garon, MD, is the Director of the Thoracic Oncology Program at the University of California, Los Angeles (UCLA) Jonsson Comprehensive Cancer Center; he is also a Health Sciences Associate Clinical Professor of Hematology-Oncology at UCLA's David Geffen School of Medicine. His current research focuses on advancing the understanding of which patients with NSCLC will respond to immunotherapy. Dr. Garon has been the principal investigator of numerous national and international clinical trials, including ones that have led to the approval of both ramucirumab and pembrolizumab for the treatment of NSCLC.
For More Information
Garon EB, Hellmann MD, Rizvi NA, et al (2019). Five-year overall survival for patients with advanced non‒small-cell lung cancer treated with pembrolizumab: results from the phase I KEYNOTE-001 study. J Clin Oncol. [Epub ahead of print] DOI:10.1200/JCO.19.00934
Transcript edited for clarity. The views expressed above are the speaker's own and do not necessarily reflect those of i3 Health.