Pembrolizumab is first-line treatment for patients with advanced non-small cell lung cancer in both mono and combination regimens

Summary. The development of inhibitors of immune checkpoints has radically changed the approaches of the treatment of patients with advanced non-small cell lung cancer (NSCLC), resulting in promising clinical outcomes. Pembrolizumab, a humanized monoclonal antibody, that is indicated as a first‑line treatment for patients with advanced NSCLC with high PD‑L1 expression (at least 50% of the tumor proportion score, TPS). Pembrolizumab in combination with chemotherapy has shown better clinical outcomes than chemotherapy as a first‑line therapy for those patients. However, little is known about the value of adding chemotherapy to pembrolizumab in this setting. This review represents data about an indirect comparison for pembrolizumab plus chemotherapy versus pembrolizumab. The main represented data were overall survival, progression-free survival and objective response rate. Data included results of 5 randomized trials involving almost 1300 patients were comparing pembrolizumab plus chemotherapy or pembrolizumab monotherapy against chemotherapy. Direct meta-analysis showed that both pembrolizumab plus chemotherapy and pembrolizumab alone improved clinical outcomes compared with chemotherapy. Indirect comparison showed that pembrolizumab plus chemotherapy was superior to pembrolizumab alone, in terms of objective response rate and progression-free survival. A trend towards improved overall survival was also observed. Thus, the addition of chemotherapy to pembrolizumab further improves the outcomes of patients with advanced NSCLC and a PD-L1 expression TPS of at least 50%.

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