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Immunotherapy vs chemotherapy for lung cancer: 5-year survival

Interview and article by Christine Clark

IMI interviewed Dr Erin Schenk, Assistant Professor, Thoracic Oncology, University of Colorado to find out about key trial results in lung cancer and the implications for patient care. 

“Biomarkers are king! When patients are diagnosed with metastatic lung cancer, biomarkers are really important for helping people like me decide what therapies are best to treat my patient with”, explained Dr Schenk. 

The first trial that she discussed was one that illustrated the importance of the programmed death ligand 1 (PD-L1) as a biomarker. PD-L1 is a marker on cancer cells that is used to decide whether or not patients should receive immunotherapy alone or whether they might receive immunotherapy plus chemotherapy.

Recently, a five-year update to KEYNOTE 024 was published. This was a large trial that randomised patients with metastatic non-small cell lung cancer (NSCLC) to receive either pembrolizumab alone or standard of care chemotherapy. The updated, five-year overall survival results were “remarkable”, said Dr Schenk.  Of the patients who received pembrolizumab alone, almost a third were still alive at five years. “Additionally, if patients happen to have a recurrence of their lung cancer, retreating with pembrolizumab at that time is also an effective way to get the cancer under control again”, she adds.

 “This trial is one that firmly establishes the role of the PD-L1 biomarker for patients with lung cancer as well as the choice of using pembrolizumab as a first line option in patients with a high PD-L1 status”, says Dr Schenk.

The cut-off level for PD-L1 is set at 50%, so if more than 50% of cancer cells express PD-L1, it is considered to be ‘PD-L1 high’. “This cut point is one where you can have a discussion with patients about whether we use immunotherapy alone or whether we use immunotherapy plus chemotherapy”, explains Dr Schenk.

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