Clinical Decision Making in the Real World—The Perfect as the Enemy of the Good
Menée à partir de données portant sur 1 091 patients atteints d'un cancer du poumon non à petites cellules de stade avancé diagnostiqué entre 2016 et 2020, cette étude de cohorte rétrospective analyse l'association entre la durée d'une immunothérapie de première ligne (2 ans ou au-delà) et la survie globale
As clinicians, we strive to integrate the strongest evidence to support optimal management, but every day we are forced to make clinical decisions without comparative data providing a clear path. For patients with advanced non–small cell lung cancer (NSCLC) who receive an immune checkpoint inhibitor (ICI) as first-line therapy, whether as monotherapy or combined with chemotherapy, most clinical trials have limited the duration of immunotherapy to 2 years. But is that optimal? Five-year follow-up has found that 46.4% of patients with high tumor programmed cell death ligand 1 (PD-L1) expression who received treatment with pembrolizumab monotherapy during the KEYNOTE-024 trial before discontinuing at 2 years remained alive without further treatment or disease progression; in the KEYNOTE-407 trial of patients with advanced squamous NSCLC (with no restriction by PD-L1 expression) that administered chemotherapy/pembrolizumab for 4 cycles followed by maintenance pembrolizumab alone for up to 2 years, 43.6% of those who completed 2 years of treatment remained alive without progression or subsequent therapy at the last follow-up. We can only speculate about whether the proportion of patients alive without progression would be substantially higher if treatment with immunotherapy continued longer.
JAMA Oncology 2023