![]() ![]() In this context, the present study aimed to figure out which therapy was the priority in this specific population by head-to-head comparison. Several meta-analyses compared the efficacy of PC and PM indirectly but presented paradoxical result, which might be due to the inherent limitation such as the risk of systematic bias and confounding factors ( 5, 7– 9). Of note, PM has been given a high-priority rating though it is difficult to figure out which one was the best option due to the absence of direct comparison. They found that pembrolizumab plus chemotherapy was superior to pembrolizumab alone in terms of PFS and OS in patients with PD-L1 ≥50% ( 5).Īt present, PC and PM are both recommended with high evidence quality in NSCLC patients with PD-L1 TPS ≥50% without EGFR/ALK alterations according to NCCN and ASCO guideline ( 6). also compared the efficacy of I + C treatment and immunotherapy alone indirectly but reported different results. But the PFS benefit did not translate into an OS benefit (HR 0.75, 95% CI 0.51–1.10) ( 4). They found that I + C was superior to immunotherapy alone in terms of PFS (HR 0.54, 0.35–0.82) in patients with PD-L1 ≥50%. conducted an indirect comparison of clinical outcomes between immunotherapy plus chemotherapy (I + C) and immunotherapy alone. Of interest, in patients with PD-L1 ≥50%, there seemed to be not much difference of the median PFS and the 2-year overall survival rate between the PM group in KEYNOTE-024 and the PC group in KEYNOTE-189. ![]() The 2-year overall survival rate was 51.9% ( 3). Meanwhile, updated analysis of KEYNOTE-189 demonstrated that the PFS and OS of patients with PD-L1 ≥50% in the PC group were 11.1 and were not reached. The 2-year overall survival rate was 51.5%, which was a breakthrough for NSCLC patients without EGFR/ALK mutation ( 1). The median PFS and OS of the PM group were 10.0 and 30.0 months, respectively. ![]() Recently, updated analysis of KEYNOTE-024 showed that PM continued to provide remarkable clinical outcomes. Meanwhile, KEYNOTE-189 and KEYNOTE-407 revealed that pembrolizumab plus platinum-based chemotherapy (PC) significantly improved survival outcomes compared with chemotherapy in patients with metastatic non-squamous and squamous non-small-cell lung cancer (NSCLC), respectively. Single-agent pembrolizumab becomes the standard of care in treatment-naïve NSCLC patients with a PD-L1 TPS ≥50% building on the results of KEYNOTE-024 study. PM achieved a remarkable improvement in terms of progression-free survival and overall survival (OS HR, 0.63 95% CI, 0.47 to 0.86) ( 1, 2). The KEYNOTE-024 study compared pembrolizumab monotherapy (PM) versus chemotherapy in treatment-naïve patients with advanced non-small-cell lung cancer (NSCLC) with programmed death ligand 1 (PD-L1) tumor proportion score (TPS) of 50% or greater. Pembrolizumab, an IgG4 monoclonal antibody against programmed cell death protein 1 (PD-1) has become a powerful treatment option in clinical practice nowadays. The use of immune checkpoint inhibitors has greatly altered the standard of care in patients with advanced NSCLC. The ORR was 61.7 and 46.9% (p = 0.004), respectively.Ĭonclusion: In patients with previously untreated, PD-L1 ≥50%, advanced NSCLC without EGFR or ALK mutations, the addition of pembrolizumab to standard platinum-based chemotherapy seems to be the preferred treatment, which needs to be validated by further prospective trials. The 1-year overall survival rates of PC and PM were 89.3% and 76.1%, respectively. Subgroup analysis found that the PFS benefit of PC was evident in most subgroups excepting patients with brain metastasis. The median overall survival (OS) rates were NE and 28.91 months (HR: 0.40, p = 0.005), respectively. The median progression-free survival (PFS) rates of PC and PM were 12.37 and 9.60 months (HR: 0.44, p < 0.001), respectively. Up to Dec 30, 2020, median follow-up was 17.13 months. Result: Among the population, 115 patients received PC, and 91 patients received PM. Method: In this retrospective analysis, we compared the clinical efficacy of PM and PC as first-line treatment in NSCLC patients with a PD-L1 ≥50% and negative for genomic alterations in the EGFR and ALK genes. This study aimed to figure out the better treatment choice. Objectives: Pembrolizumab plus platinum-based chemotherapy and pembrolizumab monotherapy (PM) both become standard of care in patients with advanced non-small-cell lung cancer (NSCLC) and a programmed death ligand 1 (PD-L1) tumor proportion score (TPS) greater than 50%. Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.Ya Chen † Yanan Wang † Zhengyu Yang † Minjuan Hu Yanwei Zhang Fangfei Qian Wei Zhang * Bo Zhang * Baohui Han * ![]()
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