Dr. Brahmer on Immunotherapy in Stage IV NSCLC

Julie R. Brahmer, MD, associate professor of oncology, co-director of the Upper Aerodigestive Department, Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins Medicine, discusses immunotherapy for patients with stage IV non—small cell lung cancer (NSCLC).

For the majority of patients with stage IV NSCLC, there are many options for treatment. Single-agent pembrolizumab (Keytruda) can be used in patients with PD-L1 staining of ≥50%, based on data from the KEYNOTE-024 and KEYNOTE-042 studies. Brahmer says that the benefit of pembrolizumab was mainly seen in patients with high PD-L1 expression, which may have carried the survival benefit.

In KEYNOTE-024, there was a 37% reduction in the risk of death in patients with metastatic NSCLC who received frontline pembrolizumab (HR, 0.63; 95% CI, 0.47-0.86; P = .002). The median overall survival was 30.2 months with pembrolizumab versus 14.2 months with chemotherapy.

Results from the KEYNOTE-042 study showed that patients with NSCLC treated with frontline pembrolizumab lived 4 to 8 months longer than those who received standard of care chemotherapy, depending on their level of PD-L1 expression.