As discussed in Drugline Volume 354, pembrolizumab is available on the Pharmaceutical Benefits Scheme (PBS) for the first-line treatment of metastatic non-small cell lung cancer.

In the original KEYNOTE-024 trial, the median duration follow up was 11.2 months and pembrolizumab was associated with a significantly longer progression-free survival (10.3 versus 6.0 months) and overall survival at six months (80.2% versus 72.4%) compared to platinum-based chemotherapy.

An updated analysis of KEYNOTE-024 with a median follow up duration of 25.2 months demonstrated pembrolizumab to have a significantly improved overall survival (30 months vs 14.2 months) and a median duration of response not reached.

The 24-month overall survival rate was 51.5% in the pembrolizumab group vs 34.5% in the chemotherapy group.

The incidence of treatment-related adverse effects remains consistent as the interim data, pembrolizumab at 76.6% and chemotherapy at 90%. However, immune-mediated adverse effects including hypo- and hyperthyroidism, pneumonitis, skin toxicity and infusion reactions were markedly higher, with pembrolizumab at 33.8% and chemotherapy at 5.3%.

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