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Expert Interview

Slingshot members are talking to an expert! The topic is:

Digging into Merck's Keytruda as a first-line monotherapy in locally advanced or metastatic NSCLC with TPS of ≥1

Ticker(s): MRK

Who's the expert?

An oncologist with experience in treating Non-small cell lung cancer (NSCLC), prescribing and having knowledge about Merck’s Keytruda (pembrolizumab).

Interview Questions

Please tell us about your professional/clinical experience. What are the challenges you encounter treating Non-small cell lung cancer and choosing the medication for your patients? What is the first line of therapy of your choice and why? Where would Keytruda stand if approved, vs established drugs in NSCLC?

Added By: slingshot_insights

With the recent approval in China as first line in NSCLC in combination with pemetrexed and platinum chemotherapy, what chances of an approval does it have as standalone therapy in the US?

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After first getting approved in the US in 2015 in NSCLC patients with disease progression on other treatments, what chances does it stand as standalone therapy 3 years later? Would you consider it for first line therapy if approved now, and the reasons why?

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Back in 2015, KEYNOTE-001 study reported that out of 550 patients, Tumors had shrank in 41 percent of those treated with Keytruda and the effect lasted between 2.1 and 9.1 months. Severe immune-mediated side effects occurred involving the lungs, colon and hormone-producing glands. Guillain-Barre Syndrome had also occurred in some patients. How does this data stand now, 4 years later, when compared to real cases you've been encountering?

Added By: slingshot_insights

Have you been using Keytruda in patients with high PD-L1 expression squamous cell carcinoma as first line therapy, with or without Carboplatin and Either Paclitaxel or Nab-Paclitaxel, since the combination approval in 2016? What impact has it made so far in this space?

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In KEYNOTE-189, KEYTRUDA + pemetrexed and platinum chemotherapy resulted in OS (HR=0.49 [95% CI, 0.38-0.64]; p<0.00001), reducing the risk of death by half compared to chemotherapy alone. The study also showed PFS (HR=0.52 [95% CI, 0.43-0.64]; p<0.00001). What is your interpretation of this data?

Added By: slingshot_insights

In the phase III KEYNOTE-042 trial, the median overall survival was 16.7 months with frontline pembrolizumab monotherapy compared with 12.1 months with standard chemotherapy in patients with advanced or metastatic NSCLC and TPS ≥1% (HR, 0.81; 95% CI, 0.71-0.93; P = .0018). Across all patients with PD-L1 TPS of 1% to 49%, the median OS was 13.4 months with pembrolizumab compared with 12.1 months for chemotherapy (HR, 0.92; 95% CI, 0.77-1.11). How do you interpret this data? Does it make a strong argument for use as first line therapy in patients with TPS of 1% to 49%?

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