Pembrolizumab +/- Chemotherapy in Lung Cancer: Reading Between the Studies

This transcript has been edited for clarity.

This is Mark Kris from Memorial Sloan Kettering. I'm making the first of, hopefully, an ongoing series of presentations entitled "Reading Between the Studies."

What do you do when you need information and you look to clinical trials to give you that information to care for an individual patient, but you don't find a trial that is exactly on point?

One of these situations is a common one: [What is the role] of chemotherapy with a checkpoint inhibitor in patients with lung cancers that have programmed death-ligand 1 (PD-L1) expression greater than 50%? There is universal agreement that these patients, unless there's a contraindication, should receive a checkpoint inhibitor. But who in that group could also benefit from chemotherapy?

I was kind of surprised to note that there are no clinical trial data that are available to guide this decision. What we're really forced to do is to look at the trials that exist now, including trials of chemotherapy vs pembrolizumab alone and also trials of chemotherapy vs the combination of chemotherapy and checkpoint inhibitor — in this case, pembrolizumabI know this is not an ideal comparison, obviously it's cross-trial comparison and you don't want to do that, but this is a situation we're all faced with on an almost daily basis. We need to take the information that's out there. What does the information from the two trials show?