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Ramalingam Highlights Immunotherapy Advances in NSCLC

Danielle Bucco
Published: Thursday, Feb 22, 2018

Suresh S. Ramalingam, MD
Suresh S. Ramalingam, MD
Recently reported updates from the KEYNOTE-189 and IMpower150 trials demonstrated the powerful impact of adding immunotherapy to treatment regimens for patients with non–small cell lung cancer (NSCLC).

, Suresh A. Ramalingam, MD,  deputy director of Winship Cancer Institute of Emory University, discussed the exciting findings from the KEYNOTE-189 and IMpower150 immunotherapy trials in patients with NSCLC.

OncLive: What are the latest data that we have with frontline pembrolizumab and chemotherapy in NSCLC?

Ramalingam: Cohort G of the KEYNOTE-21 trial, which was a randomized phase II study, showed that adding pembrolizumab to chemotherapy in patients with nonsquamous disease was associated with an improved PFS, high response rates, and a trend toward improved survival. That appears to be confirmed by the KEYNOTE-189 study. This has not been formally reported, but we learned from a press release that a large phase III trial that asks the same question in the same group of patients, showed significant improvement in efficacy with the addition of pembrolizumab to chemotherapy in the frontline setting.

In the 1% to 50% population, chemotherapy plus pembrolizumab may be more attractive because pembrolizumab alone is not commonly used for those patients. When we see the KEYNOTE-189 results and see the PD-L1 expression status, we will have a better sense for which patients should get chemotherapy in combination with immune checkpoint inhibition and which group may be best treated with immunotherapy alone. 

Can you discuss the IMpower150 data looking at the combination of atezolizumab, bevacizumab, and chemotherapy?

The IMpower150 study was also a chemotherapy plus a checkpoint inhibition study. The difference here is that patients were treated with carboplatin, paclitaxel, and bevacizumab as the control group. The experimental groups had carboplatin, paclitaxel, and bevacizumab plus atezolizumab. There was a third experimental group with carboplatin, paclitaxel, and atezolizumab alone, but we have not seen the formal results from that comparison.

We know that when compared to chemotherapy plus bevacizumab, the addition of atezolizumab resulted in a significant improvement in PFS. The hazard ratio was 0.6 and the survival results are not mature yet. This was for all nonsquamous patients and those with contraindications to bevacizumab were excluded.

This large trial shows a benefit for adding atezolizumab to carboplatin, paclitaxel, and bevacizumab and also had a biomarker question built in. We showed that the biomarker-positive group had an even better PFS hazard ratio of 0.5. This tells us that the combination treatment is helpful, but the benefits appear to be with the patients with the highest PD-L1 expression status. 

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