Keytruda shows survival edge over Tecentriq, Opdivo in older patients with lung cancer

Older adults with metastatic non-small cell lung cancer treated first-line with Keytruda (pembrolizumab) lived longer than those who received Tecentriq (atezolizumab) or Opdivo (nivolumab), according to a new study out of Auburn University in Alabama. The findings were published Oct. 31 in the Journal of Managed Care & Specialty Pharmacy.

Lung cancer remains the leading cause of cancer-related deaths among adults in the United States. Non-small cell lung cancer (NSCLC) accounts for up to 85% of all lung cancer cases, with the majority of cases diagnosed after the disease has already spread. Despite major advances in immunotherapy over the past decade, only 12% of people with metastatic NSCLC are still alive five years after diagnosis.

The population-based study was led by Xiangzhong Xue, Ph.D., who conducted the research while at Auburn University and is now at Harvard University and Brigham & Women’s Hospital in Boston. Senior corresponding author Jingjing Qian, Ph.D., an associate professor in the Department of Health Outcomes Research and Policy at Auburn University’s Harrison College of Pharmacy, said the research was designed to generate real-world evidence comparing three commonly used immune checkpoint inhibitors (ICIs) in older adults.

The study showed that first-line immunotherapy treatment with Keytruda “provided a significant overall survival benefit compared to atezolizumab [Tecentriq] and nivolumab [Opdivo] among older patients with metastatic non-small cell lung cancer,” Qian told MHE.

“This finding is particularly important for patients aged 66 and older, who are often underrepresented in clinical trials,” Xue told MHE.

Using 2014-2020 Surveillance, Epidemiology and End Results (SEER) Medicare data, the researchers identified 4,635 patients aged 66 and older with metastatic NSCLC who began first-line treatment with Tecentriq, Opdivo or Keytruda. The investigators compared overall survival among the three groups using statistical models that adjusted for differences in patient characteristics.

The analyses revealed that patients treated with Keytruda lived significantly longer, on average, than those who treated the other two checkpoint inhibitors. Keytruda was linked to a 33% lower risk of death compared with Tecentriq (adjusted hazard ratio [HR], 0.67) and a 17% lower risk compared with Opdivo (adjusted HR, 0.83). The survival difference between Opdivo and Tecentriq was inconclusive. Subgroup analyses revealed no significant difference in survival between Keytruda and Opdivo among patients with squamous histology.

The authors noted that their results add to a limited body of comparative real-world data on ICIs. Previous smaller studies had not detected survival differences between these therapies, likely due to sample size limitations. Head-to-head trials comparing ICIs have been limited, making real-world data an important source of insight. The current analysis, one of the largest of its kind, supports a survival benefit with Keytruda while highlighting variability by tumor histology.

These findings may help inform evidence-based treatment selection, formulary management and clinical guideline development, according to the authors.

“For managed care organizations and healthcare systems, these results suggest that pembrolizumab may offer a survival advantage in routine practice,” Xue said. “Continued real-world evaluations are essential as new immunotherapy regimens enter the market to ensure that treatment decisions remain evidence-based and reflect the populations seen in everyday care.”

The findings also indicate “the need for more research on nivolumab’s effectiveness in squamous subtypes as well as the comparison between atezolizumab and nivolumab,” Qian said.