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

Résumé en anglais

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.