Sunrise or sunset in NSCLC?

Is it time for the dawn of a new era in early stage lung cancer or are the initial trials more of a sunset on future opportunities due to more modest than expected data?

One challenge with interim readouts in the adjuvant setting is they are a reflection of the top part of a very long survival curve, so large differences are rarely apparent at this stage when the timeline might be going out 10-12 years.  This is especially true for IO studies where these agents have consistently shown to impact landmark survival and the long tail of the Kaplan-Meier curves.

While previous studies more than a decade ago have shown some benefit for chemotherapy over observation in terms of overall survival, we have no other reference points in lung cancer, unlike breast and colon trials where some targeted therapies have seen success in the adjuvant setting.

This is very much a case then of ‘once more unto the breach, dear friends,’ as Shakespeare would say.

We have already seen approvals for immunotherapies in both neoadjuvant (nivolumab) and adjuvant (durvalumab and atezolizumab) stages of lung cancer, now it’s time to put pembrolizumab in the spotlight…

Are they building a cathedral or a brick wall?

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