When we move cancer drugs from the second or third to the first line of treatment: what lessons can we learn from KEYNOTE-177 and JAVELIN-100

If the current standard of care is to give a new cancer drug as the second or third treatment option for a patient and there is interest in moving the drug to the front-line setting, how should we design and evaluate the study? Two recent examples can help us make sense of this question. The recent KEYNOTE-177 Study1 evaluated pembrolizumab in microsatellite-instability-high (MSI-high) advanced colorectal cancer found that front-line use of pembrolizumab is associated with an improved progression-free survival (PFS), median 16.5 months versus 8.2 months, compared with standard chemotherapy. Similarly, JAVELIN-1002 found that among patients with metastatic urothelial cancer who achieved at least stable disease after four to six cycles of therapy, the use of maintenance avelumab increased median PFS from 2.0 months to 3.7 months and median overall survival (OS) from 14.3 months to 21.4 months. Both pembrolizumab and avelumab are checkpoint inhibitors...
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: EBM opinion and debate Source Type: research