Although we’re still somewhat early in the game, the latest clinical trial for immunotherapy combined with chemotherapy for lung cancer has just been released with exciting results. Non-small cell lung cancer is the leading cause of all cancer death, in part because in the majority of cases, the cancer has already spread at the time of diagnosis.

Thus, it is always important to lengthen the survival time of patients with metastatic cancer. Of the 616 patients in this latest trial, the patients whose immune systems were treated with Keytruda survived four months longer than those who were not.

The phase 3 KEYNOTE-189 trial enrolled 616 patients with metastatic non-small cell lung cancer. Patients who received pembrolizumab (Keytruda) with chemotherapy had improved duration of tumor control and improved overall survival. At one year, 69 percent of the patients who received pembrolizumab and chemotherapy were alive, compared with 49 percent of the patients who received chemotherapy alone.

On average, the study found, cancer was controlled for almost nine months in patients who received pembrolizumab with chemotherapy, compared with five months in patients who received chemotherapy and a placebo. Also, tumor shrinkage of at least 30 percent was observed in 48 percent of the patients who received pembrolizumab with chemotherapy; it was 19 percent in patients who received chemotherapy alone.

Principal investigator Leena Gandhi, MD, PhD, director of the thoracic medical oncology program at Perlmutter Cancer Center at NYU Langone Health and associate professor of Medicine in the division of Medical Oncology at NYU School of Medicine, presented these findings April 16 at the American Association for Cancer Research (AACR) Annual Meeting 2018 in Chicago. The data from this study were simultaneously published online April 16 in the New England Journal of Medicine.

The results of this trial were so exciting that Keytruda will probably be used as a first line treatment, rather than waiting until all other treatments have failed. Doctors hope that one day immunotherapy can replace chemotherapy, with its terrible taxes on the body, but that’s not in the near future, Only certain tumors, newly-diagnosed advanced non-small cell lung cancer (NSCLC) in patients with a high tumor mutational burden (TMB) have been shown to benefit thus far.

TMB is a potentially important new biomarker for identifying those most likely to benefit from immunotherapy.

There are other important caveats, according to Dr. Gandhi:

“Although some non-small cell lung cancer patients have increased benefit of targeted therapy or immunotherapy instead of chemotherapy, for some groups of patients with NSNSCLC, chemotherapy has been the standard treatment for more than 30 years,” Gandhi notes. “But for patients with NSNSLC without EGFR or ALK alterations, this study may suggest a new standard of care.”