In patients with metastasized lung cancer, the combination of immunotherapy and chemotherapy improves survival by 50%.
In the most common lung cancer, non-small cell lung cancer, a new study presented at an American cancer conference, the AACR, demonstrates the value of combining immunotherapy with the usual chemotherapy in metastasized forms .
Immunotherapy consists of blocking a PD-1 or PD-L1 receptor, located on the surface of cells, and which intervenes in the camouflage of cancer cells vis-à-vis the immune system.
The KEYNOTE-189 study, performed in metastatic lung cancer, confirms results of other immunotherapies in previous studies, namely cancer response rates of nearly 70% when combined with standard chemotherapy, versus 50% with chemotherapy alone.
A study in metastasized lung cancer
KEYNOTE -189 is a controlled trial with independent evaluation (double-blind), in 616 patients, which compared pembrolizumab, an anti-PD-L1 antibody, to placebo, in addition to standard chemotherapy (pemetrexed and cisplatin or carboplatin).
The patients had metastatic non-small cell lung cancer without EGFR or ALK mutation which could have indicated specific treatment. The 2 main criteria are overall survival and disease progression-free survival.
Improved survival
At the end of a 12-month follow-up, overall survival is 69.2% in patients in the immunotherapy group (pembrolizumab) versus 49.4% in the placebo group. The disease progression-free survival (median progression-free survival) is also in favor of immunotherapy with 8.8 months and 4.9 months in the placebo group.
The frequency of severe side effects, those of grade 3 or more, is not different between the 2 groups, which suggests that immunotherapy does not worsen the toxicity of chemotherapy: they are found in 67.2% of patients. patients in the pembrolizumab and chemotherapy group versus 65.8% in the placebo and chemotherapy group.
Original Article: Pembrolizumab plus Chemotherapy in Metastatic Non – Small-Cell Lung Cancer (KEYNOTE-189) https://t.co/CvLQxOSDGk # AACR18 pic.twitter.com/ClZQbnXRnY
– NEJM (@NEJM) April 16, 2018
An independent response from predictive testing
Pembrolizumab is an anti-PD-L1 monoclonal antibody and it would therefore be logical that the effectiveness of this immunotherapy is dependent on the number of cells in which there is PD-L1. In reality, it is a blocking antibody and tests to measure PD-L1 status seem to be relatively inefficient: it is therefore common to observe in studies a certain disconnection between PD-L1 status and efficacy. processing.
In KEYNOTE -189 all patients in the pembrolizumab group had a benefit, regardless of the level of expression of the PD-L1 antigen on the surface of their cancer cells: this is the case even in patients whose PD-L1 expression is less than 1%. However, the best results are obtained when there is an expression greater than 50%.
These results show that the combination of immunotherapy and chemotherapy would be beneficial in lung cancer, the hypothesis is that part of the cancer cells are destroyed by chemotherapy, which activates the immune system and makes the tumor more visible to people. him.
.
