Choice of taxane and addition of pembrolizumab for metastatic squamous non-small-cell lung cancer

Prof. Balazs Halmos (Albert Einstein College of Medicine and Montefiore Medical Center, USA) presented a study on the choice of taxane and KEYNOTE-407 outcomes. His presentation was part of a mini-oral abstract session on real-world considerations in immunotherapy. It focused on an exploratory analysis of data by investigators’ choice of paclitaxel (60.1% of patients) or nab-paclitaxel (39.9% of patients).

KEYNOTE-407 was a phase 3, randomised, double-blind clinical trial in patients with advanced, untreated squamous cell carcinoma [4]. Key eligibility criteria were an ECOG of 0-1, available tissue sample for PD-L1 testing, no symptomatic brain metastasis, and no pneumonitis requiring systemic steroids. Other than a higher percentage of East-Asian patients treated with nab-paclitaxel, baseline characteristics between the two groups were well balanced. They were stratified by choice of taxane, region of enrolment (Eastern Asia vs the rest of the world), and PD-L1 tumour proportion score. OS in the pembrolizumab arm was significantly better than placebo regardless of choice of taxane (see Figure). The HR in the paclitaxel group was 0.67 vs 0.59 in the nab-paclitaxel group. However, Dr Halmos noted that although survival appeared to be numerically better in both arms for the nab-paclitaxel patients, confidence intervals were wide and overlapped.

Figure: Overall survival in an exploratory analysis of taxane choice and KEYNOTE-407 outcomes [4]



Progression-free survival benefits were also significantly better. The HR was 0.52 in the paclitaxel cohort and 0.65 in the nab-paclitaxel patients. The addition of pembrolizumab to chemotherapy boosted ORR by about 20% in both groups.

According to Dr Halmos, the findings demonstrate significantly improved overall survival, progression-free survival, response rate, and an acceptable safety profile regardless of taxane choice. “Our data clearly support the addition of pembrolizumab to carboplatin/taxane-based doublet chemotherapy for first-line management of advanced squamous cell NSCLC,” he said.