Dr. Brahmer on the Role of Immunotherapy in Metastatic 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 the role of immunotherapy in the treatment of patients with metastatic non—small cell lung cancer (NSCLC).

The majority of patients with metastatic NSCLC are being offered immunotherapy based on several trials. One of the KEYNOTE trials compared the use of pembrolizumab (Keytruda) with chemotherapy in patients with high PD-L1 expression. The tumor proportion score showed an improvement in survival, making pembrolizumab an option for patients who do not express EGFR or ALK. For the rest of the patients, the standard of care is a combination of immunotherapy and chemotherapy, says Brahmer.

Two separate KEYNOTE trials investigated pembrolizumab in combination with chemotherapy versus chemotherapy alone. In cohort G of the KEYNOTE-021 trial, investigators looked at nonsquamous histologies and tested pembrolizumab with pemetrexed and carboplatin. The KEYNOTE-407 trial evaluated the use of nab-paclitaxel (Abraxane) or paclitaxel and carboplatin plus pembrolizumab versus chemotherapy alone. Both trials showed an advantage with the addition of pembrolizumab to chemotherapy, states Brahmer.