The KEY to going chemo-free.

The final publication of KEYNOTE-042 is finally here. In case you missed our ASCO coverage (and Merk's marketing), upfront pembrolizumab monotherapy improves survival over standard chemo for anyone with metastatic NSCLC with no EGFR- or ALK-aberrations and a PD-L1 expression of only 1% or higher. What’s happened since this trial was designed? Well, ablative radiation for oligometastatic NSCLC responding to upfront cytotoxic chemo. So when do you consolidate on immunotherapy alone? Great question, but sorry no great answer. In 042, we see that 30-40% of patients respond to immunotherapy—with imaging to assess response done every 9 weeks on trial. For responders, the median duration was an impressive 20 months. The interactions we’d typically worry about with cytotoxic chemo also aren’t there. In 042, less than 20% on pembro had G3+ events with the most common adverse event being the very anticlimactic hypothyroidism. TBL:As many as two-thirds of patients with metastatic NSCLC are now potentially eligible for first-line pembro monotherapy, and early consolidation with SBRT in those without progression likely offers low risk and high reward. | Mok, Lancet 2019