Breakthrough 5-year survival with pembrolizumab in Keynote-001 study: horizon shifting in advanced non-small cell lung cancer with immune check point inhibition

摘要

Lung cancer remains the leading cause of cancer-related deaths worldwide, and non-small cell lung cancer (NSCLC) the most common type of lung cancer is responsible for around 85% of cases ( , ). Unfortunately, the majority of people diagnosed with NSCLC will have advanced disease at diagnosis with palliative systemic therapy the main treatment option. Since the realisation that systemic chemotherapy can improve survival over best supportive care in 1995, platinum-based chemotherapy has been the mainstay of upfront treatment ( ). Since then, our understanding of the NSCLC biologic sub-types has enabled therapy selection by subgroups and a more personalised approach over empiric systemic therapy, especially with the use of receptor tyrosine kinase inhibitors (TKIs) for the small subset of patients with oncogenic driven cancers. Yet 5-year overall survival for patients with advanced/metastatic NSCLC has remained poor and <5% ( ). For the remaining majority of patients with and “wild-type” NSCLC treated empirically, a breakthrough has come with the discovery of immunotherapy. The Keynote-001 study, a phase Ib, multi-cohort adaptive study, was the first trial to evaluate pembrolizumab in locally advanced or metastatic NSCLC ( ). First reported in 2015 and now updated with 5-year overall survival data in 2019 it has demonstrated renewed hope for longer term survival for patients with advanced NSCLC ( , ).