Five-Year Outcomes With Pembrolizumab Versus Chemotherapy for Metastatic Non‑Small‑Cell Lung Cancer With PD‑L1 Tumor Proportion Score ≥ 50%
Pembrolizumab provides a durable, clinically meaningful long‑term overall survival benefit versus chemotherapy as first‑line therapy for metastatic NSCLC with PD‑L1 tumor proportion score of at least 50%.
KEYNOTE‑024, a first‑line phase III randomized controlled trial, followed patients with metastatic non‑small‑cell lung cancer (NSCLC) harboring PD‑L1 tumor proportion score (TPS) ≥ 50% and no EGFR or ALK alterations for 5 years. 154 patients received pembrolizumab and 151 received platinum‑based chemotherapy. The median overall survival (OS) was 26.3 months (95 % CI 18.3–40.4) for pembrolizumab versus 13.4 months (95 % CI 9.4–18.3) for chemotherapy (hazard ratio 0.62, 95 % CI 0.48–0.81). Five‑year OS rates were 31.9 % (95 % CI 24.5–39.5) versus 16.3 % (95 % CI 10.6–23.0). Progression‑free survival (PFS) also favored pembrolizumab (median 7.7 months vs 5.5 months, HR 0.50). These long‑term results confirm the durable benefit of upfront checkpoint inhibition in this patient population.
The 5‑year survival data support the continued use of pembrolizumab monotherapy as the standard of care for metastatic NSCLC with high PD‑L1 expression, demonstrating that immunotherapy confers a lasting survival advantage over conventional chemotherapy in this clinically significant subgroup.
Evidence level: Irányelv / elfogadott gyakorlat. Magas szintű klinikai elfogadottság.
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