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The first trial to show that immunotherapy after lung cancer surgery delays recurrence. The benefit was concentrated in patients whose tumours expressed PD-L1.
The IMpower010 investigators, reported by Felip, Altorki, Zhou and colleagues with Wakelee as senior author, randomised 1,005 of 1,280 enrolled patients with completely resected stage IB (tumours 4 cm or larger) to IIIA non-small-cell lung cancer, after one to four cycles of adjuvant platinum chemotherapy, to atezolizumab 1200 mg every 21 days for 16 cycles or a year (507) or best supportive care (498), across 227 sites in 22 countries.
The hierarchical testing order is the result. The PD-L1-positive stage II to IIIA group cleared the bar comfortably, the whole stage II to IIIA group marginally, and the intention-to-treat population barely, which is why regulators restricted the indication to PD-L1-positive stage II to IIIA disease rather than granting what the trial nominally showed.
Adjuvant immunotherapy entered lung cancer here, and with it the question that still divides practice: whether it is better given before the operation, after it, or on both sides.
Perioperative immunotherapy is now standard for resectable lung cancer without a targetable driver. The updated overall survival hazard ratio of 0.89, with a confidence interval crossing one, is the honest state of the evidence on whether it cures more people.
This is the paper Europe PMC returns for registry id NCT03425643 with the most citations, so it is the natural first reading for anyone following the KEYNOTE-671 trial. Read the abstract above alongside the trial page and the registry entry; the record was linked automatically and its figures have not been checked by hand.
The rule that a patient with a resected stage II or III lung cancer is offered chemotherapy and a patient with a small stage I tumour is not. Everything added to adjuvant treatment since has had to beat, or be added to, this 5 percent.
Shares Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer, Perioperative durvalumab for resectable non-small-cell lung cancer, CheckMate 816: three cycles of nivolumab plus chemotherapy before lung cancer surgery, Immune checkpoint and the tag lung-evidence.
Shares Immune checkpoint, PD-L1-high non-small-cell lung cancer without a driver mutation, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Immunohistochemistry (IHC) and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Dormant cells and minimal residual disease, Neoadjuvant / adjuvant / perioperative and the tag lung-evidence.
Shares Immune checkpoint, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, No one can predict who responds to immunotherapy, The Lancet and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Neoadjuvant / adjuvant / perioperative, Cisplatin and the tag lung-evidence.
Shares Immune checkpoint, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, No one can predict who responds to immunotherapy, Biomarkers are not validated or standardised and the tag lung-evidence.
Shares Immune checkpoint, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, No one can predict who responds to immunotherapy, PD-L1 and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Dormant cells and minimal residual disease, Resectable stage I to III non-small-cell lung cancer and the tag lung-evidence.