Too Much Treatment

By comparing pembrolizumab with placebo, KEYNOTE-054 may also be able to give insight into whether some patients with resected stage III disease may be able to forego adjuvant therapy altogether, Dr Gastman said. In the study, if a recurrence occurred, patients were eligible for crossover or to repeat treatment with pembrolizumab.

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“When giving adjuvant treatment we are treating patients that will recur, but we are also treating patients that will not recur,” Dr Gastman said. “It may be that waiting until disease recurs and then treating the right people will result in the same benefit, though by waiting we will be treating patients with a much bigger disease burden.”

Dr Gastman said the KEYNOTE-054 RFS results will likely be enough to drive FDA approval of pembrolizumab in the adjuvant setting.

Yet when it comes to whether nivolumab is superior to pembrolizumab, he noted that the 2 drugs are “very similar.” One possible advantage to pembrolizumab is the every 3 weeks treatment schedule compared with the every 2-week schedule of nivolumab.

“I think a lot of patients might shift to this because it is an easier schedule for them,” Dr Gustman said.

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