Dr. Brahmer on Chemoimmunotherapy in Patients With NSCLC

Julie R. Brahmer, MD, associate professor of oncology, co-director of the Upper Aerodigestive Department, Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins Medicine, discusses the use of chemoimmunotherapy in patients with non—small cell lung cancer (NSCLC).

The main source of advancement in NSCLC has been chemotherapy and immunotherapy combinations, explains Brahmer. The KEYNOTE studies in particular, which combined pembrolizumab (Keytruda) with various chemotherapy backbones, showed an advantage in survival in patients with metastatic disease.

Physicians have data from the KEYNOTE-189 trial in nonsquamous cell histologies combining pemetrexed, carboplatinum, or cisplatin plus pembrolizumab. That trial showed a survival advantage with the addition of pembrolizumab. The KEYNOTE-407 study combined carboplatinum, paclitaxel, or nab-paclitaxel (Abraxane) with pembrolizumab compared with a carboplatinum-based doublet in patients with squamous cell histology. This trial also showed a survival advantage with the addition of pembrolizumab. Based on these data, most physicians would recommend the combination of immunotherapy with chemotherapy. However, select patients with a high PD-L1 expression can still receive single-agent pembrolizumab, notes Brahmer.