‘A new treatment option for lung cancer’ – Written by Charlotte Harrison, Science Writer.
New clinical trial results show that combining the immune checkpoint inhibitor pembrolizumab (Keytruda) with chemotherapy and surgery slows cancer progression and recurrence in people with non-small cell lung cancer (NSCLC).
The Phase 3 trial results (NCT03425643), published in the New England Journal of Medicine, confirm that the pembrolizumab, chemotherapy and surgery regimen provides a new approach to the way we treat NSCLC.
“The combination of pembrolizumab with neoadjuvant chemotherapy showed a significantly improved survival rate in treated patients. This is a message of hope for NSCLC patients,” said the authors in a press release.
The trial had almost 800 participants, all with surgically removable NSCLC of stage II or III. Half of these received pembrolizumab plus chemotherapy before and after surgery, and the other half received placebo plus chemotherapy before and after surgery. The median follow-up was just over 2 years.
In the pembrolizumab group, 62% of patients remained stable for two years — without cancer progression or recurrence — compared with 40.6% in the control group; this represented an improvement of around 50%.
The estimated 24-month overall survival was 81% in the pembrolizumab group and 78% in the placebo group, which was not statistically significant.
Reduced tumour size
The trial also measured how effectivepembrolizumab was at reducing the size of tumours.A major pathological response (<10% residual viable tumours) occurred in around one-third of people in the pembrolizumab group and one-tenth of people in the control group. A complete pathological response (the absence of residual viable tumours) occurred in 18% of pembrolizumab patients and 4% of control patients.
With regards to adverse events, these were higher in the pembrolizumab group, but were consistent with those previously reported from other similar immunotherapy and surgery trials.
“This new treatment is another important step towards improved outcomes for patients…with stage II or III NSCLC who are eligible for surgery. This represents a large number of patients on an annual basis for whom improvement in survival will be very significant,” said the authors.