Pembrolizumab + pemetrexed + platinum

The drug combination "pembrolizumab + pemetrexed + platinum" is a significant treatment regimen in oncology, particularly for metastatic nonsquamous non-small cell lung cancer (NSCLC) and malignant pleural mesothelioma (MPM). This combination consists of pembrolizumab (an immunotherapy agent) with pemetrexed and platinum-based chemotherapy (either carboplatin or cisplatin). The regimen typically involves pembrolizumab 200 mg administered intravenously every 3 weeks for up to 35 cycles, combined with pemetrexed and either carboplatin or cisplatin for four initial cycles, followed by maintenance pemetrexed until disease progression or unacceptable toxicity. The KEYNOTE-189 trial demonstrated that after 5 years of follow-up, this combination therapy was associated with improved overall survival (OS) and progression-free survival (PFS) compared with placebo plus pemetrexed-platinum in patients with metastatic nonsquamous NSCLC. Key efficacy findings include: - Hazard ratio for OS was 0.60 (95% CI, 0.50 to 0.72) - Hazard ratio for PFS was 0.50 (95% CI, 0.42 to 0.60) - 5-year OS rates were 19.4% versus 11.3% for the combination versus chemotherapy alone - Among patients who completed 35 cycles of pembrolizumab, the objective response rate was 86.0% - 3-year OS rate after completing 35 cycles was 71.9% The combination is FDA-approved for: 1. First-line treatment of adult patients with metastatic nonsquamous NSCLC without EGFR/ALK alterations 2. First-line treatment of adult patients with unresectable advanced or metastatic malignant pleural mesothelioma (MPM) The toxicity profile is generally manageable. Grade ≥3 treatment-related adverse events occurred in similar proportions between the pembrolizumab combination and chemotherapy alone groups. Immune-mediated adverse events and infusion reactions were more common in the pembrolizumab group. Special attention should be paid to renal and hepatic disorders, which were the main causes of pemetrexed discontinuation during the maintenance phase. Real-world data from a study of 121 patients with advanced non-squamous NSCLC treated with this combination showed median PFS and OS of 9 and 20.6 months, respectively, confirming the efficacy seen in clinical trials. This combination therapy continues to be supported as a standard of care for patients with previously untreated metastatic nonsquamous NSCLC without EGFR/ALK alterations.

Brand names

KeytrudaAlimta

Other names

Pembrolizumab, pemetrexed, platinumPembrolizumab/pemetrexed/platinumKeytruda/Alimta/Platinum