Dr. Garon on Sequencing of Agents for Advanced Lung Cancer

Edward B. Garon, MD, director of Thoracic Oncology at the Jonsson Comprehensive Cancer Center at UCLA, discusses sequencing challenges for patients with advanced lung cancer.

In terms of sequencing, the current paradigm is that patients will receive pembrolizumab (Keytruda) as their frontline therapy if they have PD-L1 expression, explains Garon.

Two-year results from the phase III KEYNOTE-024 trial showed that frontline pembrolizumab more than doubled median overall survival (OS) compared with standard chemotherapy in patients with high PD-L1 expressing non—small cell lung cancer (NSCLC). The median OS for pembrolizumab was 30.2 months versus 14.2 months with chemotherapy, representing a 37% reduction in the risk of death (HR, 0.63; 95% CI, 0.47-0.86; P = .002).

At least 50% of patients will receive chemotherapy if they do not have that degree of PD-L1 expression. Combining these agents in the frontline setting is an area where Garon is excited to see the results of in frontline studies. There are many phase III studies that are ongoing in this area.