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The KEYNOTE-024 Precedent for Advanced-NSCLC Treatment

Panelists: Mark A. Socinski, MD, Florida Hospital Cancer Institute; Maximilian Hochmair, MD, Otto Wagner Spital; Suresh Senan, MRCP, FRCR, PhD, VU University Medical Center; Leora Horn, MD, MSc, FRCPC, Vanderbilt University Medical Center; Thomas E. Stinchcombe, MD, Duke University Health System
Published: Friday, Nov 16, 2018



Transcript: 

Mark A. Socinski, MD: Hello, and thank you for joining us today! Results of recent clinical trials in lung cancer have led us to a sea change in thoracic oncology as we persist in exploring new therapeutic targets and evaluating new ways to sequence and combine novel immuno-oncology agents. In this OncLive Peer Exchange® discussion, “Key Updates and Practice-Changing Data for Advanced NSCLC” [non–small cell lung cancer],” I am joined by an international panel of experts in lung cancer clinical research. Today we will discuss the key studies that will impact the way you treat your patients, including updates from the 2018 World Conference on Lung Cancer and the ESMO Annual Meeting.

I am Mark Socinski, executive medical director of the Florida Hospital Cancer Institute in Orlando, Florida. Participating today on our distinguished panel are Maximilian Hochmair, MD, of the Respiratory Oncology Unit at Otto Wagner Hospital in Vienna, Austria; Leora Horn, MD, MSc, FRCPC, Ingram Associate Professor at Vanderbilt University Medical School in Nashville, Tennessee; Suresh Senan, MRCP, FRCR, PhD, professor of radiation oncology at the VU University Medical Center in Amsterdam, Netherlands; and Thomas Stinchcombe, MD, professor of medicine and member of the Duke Cancer Institute in Durham, North Carolina. I look forward to a great discussion. Tom, 2 years ago at the ESMO meeting, we saw the results of KEYNOTE-024, which really changed practice; could you summarize that data?

Thomas E. Stinchcombe, MD: The KEYNOTE-024 is one of the landmark trials. It identified patients with PD-L1 [programmed death-ligand 1] tumor proportion scores greater than 50% and then randomized them to pembrolizumab or a platinum doublet. It resulted in a statistically significant improvement in progression-free survival, overall survival, and response. With the longer follow-up arm, the median survival with pembrolizumab was about 30 months; this sets the context for all subsequent trials. A single-agent pembrolizumab remains my preferred therapy for the patients with a high-tumor proportion score.

Mark A. Socinski, MD: The last update, we had a median survival of 30 months in over 50% of the population, with pembrolizumab; we haven’t seen these sort of numbers in lung cancer before.

Thomas E. Stinchcombe, MD: No, we haven’t.

Mark A. Socinski, MD: Are the patients in that category of greater than 50% being treated with chemotherapy in addition to pembrolizumab? Because obviously they were included in other studies that we’ll discuss in a moment.

Thomas E. Stinchcombe, MD: I look at the PD-L1 score in the clinical context. There are some patients who have a PD-L1 score greater than 50% who are perhaps symptomatic and borderline performance status. You get a sense that you only have 1 chance to intervene in the disease; those are the patients I’m more inclined to treat with a chemoimmunotherapy combination up front. If they’re asymptomatic or a good performance status, I tend to use single-agent immunotherapy.

Mark A. Socinski, MD: From the analysis of KEYNOTE-024 and -189, the 1-year survival is about the same, but the response rate was about 20% higher with the addition of chemotherapy. For those symptomatic patients, that’s my strategy.

Transcript Edited for Clarity 

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Transcript: 

Mark A. Socinski, MD: Hello, and thank you for joining us today! Results of recent clinical trials in lung cancer have led us to a sea change in thoracic oncology as we persist in exploring new therapeutic targets and evaluating new ways to sequence and combine novel immuno-oncology agents. In this OncLive Peer Exchange® discussion, “Key Updates and Practice-Changing Data for Advanced NSCLC” [non–small cell lung cancer],” I am joined by an international panel of experts in lung cancer clinical research. Today we will discuss the key studies that will impact the way you treat your patients, including updates from the 2018 World Conference on Lung Cancer and the ESMO Annual Meeting.

I am Mark Socinski, executive medical director of the Florida Hospital Cancer Institute in Orlando, Florida. Participating today on our distinguished panel are Maximilian Hochmair, MD, of the Respiratory Oncology Unit at Otto Wagner Hospital in Vienna, Austria; Leora Horn, MD, MSc, FRCPC, Ingram Associate Professor at Vanderbilt University Medical School in Nashville, Tennessee; Suresh Senan, MRCP, FRCR, PhD, professor of radiation oncology at the VU University Medical Center in Amsterdam, Netherlands; and Thomas Stinchcombe, MD, professor of medicine and member of the Duke Cancer Institute in Durham, North Carolina. I look forward to a great discussion. Tom, 2 years ago at the ESMO meeting, we saw the results of KEYNOTE-024, which really changed practice; could you summarize that data?

Thomas E. Stinchcombe, MD: The KEYNOTE-024 is one of the landmark trials. It identified patients with PD-L1 [programmed death-ligand 1] tumor proportion scores greater than 50% and then randomized them to pembrolizumab or a platinum doublet. It resulted in a statistically significant improvement in progression-free survival, overall survival, and response. With the longer follow-up arm, the median survival with pembrolizumab was about 30 months; this sets the context for all subsequent trials. A single-agent pembrolizumab remains my preferred therapy for the patients with a high-tumor proportion score.

Mark A. Socinski, MD: The last update, we had a median survival of 30 months in over 50% of the population, with pembrolizumab; we haven’t seen these sort of numbers in lung cancer before.

Thomas E. Stinchcombe, MD: No, we haven’t.

Mark A. Socinski, MD: Are the patients in that category of greater than 50% being treated with chemotherapy in addition to pembrolizumab? Because obviously they were included in other studies that we’ll discuss in a moment.

Thomas E. Stinchcombe, MD: I look at the PD-L1 score in the clinical context. There are some patients who have a PD-L1 score greater than 50% who are perhaps symptomatic and borderline performance status. You get a sense that you only have 1 chance to intervene in the disease; those are the patients I’m more inclined to treat with a chemoimmunotherapy combination up front. If they’re asymptomatic or a good performance status, I tend to use single-agent immunotherapy.

Mark A. Socinski, MD: From the analysis of KEYNOTE-024 and -189, the 1-year survival is about the same, but the response rate was about 20% higher with the addition of chemotherapy. For those symptomatic patients, that’s my strategy.

Transcript Edited for Clarity 
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