KEYNOTE-671 Study – Health-Related QOL Outcomes

A presentation at ASCO focused on the quality of life of patients undergoing the perioperative regimen of chemotherapy plus pembrolizumab in the Keynote 671 trial. Last year, the EFS and overall survival data indicated that patients with stage II and stage III resectable non-small cell lung cancer benefited from adding pembrolizumab to their neoadjuvant chemotherapy, followed by adjuvant immunotherapy for one year.

Understanding the tolerability and impact on the quality of life of this regimen is crucial, especially since treatment escalation is involved. Previous toxicity profiles showed no significant differences, and the immune-related adverse events were mostly low-grade and manageable, similar to findings in stage IV patients. It is particularly important to assess whether adding immunotherapy affects the quality of life of patients who are potentially cured with chemo and surgery.

The study evaluated the quality of life from baseline until surgery, during adjuvant treatment, and after adjuvant treatment using the EORTC quality of life scale (QLQ-C30) and a specific lung cancer scale. During neoadjuvant treatment, there was a slight decrease in quality of life in both treatment arms. However, during adjuvant treatment, the quality of life returned to baseline levels. After one year, patients’ quality of life was similar to what it was at baseline.

This applies to global health-related quality of life, physical functioning, role functioning, cough, dyspnea, and chest pain. The lack of significant differences between the two arms suggests that the decrease in quality of life during neoadjuvant treatment is primarily related to the chemotherapy component of the regimen, which aligns with clinical practice observations. Most toxicity experienced by patients during chemo-immunotherapy is due to chemotherapy rather than immunotherapy. Therefore, adding immunotherapy does not seem to increase toxicity or negatively impact quality of life significantly. During adjuvant treatment, patients’ quality of life tends to return to normal.

One caveat of the study is that it was a placebo-controlled trial, meaning patients in the placebo arm still had to visit the hospital every three weeks. This additional burden of frequent hospital visits during adjuvant treatment was not assessed, which might differ from real-life scenarios. However, given the overall good toxicity profile, it is reasonable to speculate that this would not significantly impact patients’ quality of life.

These findings reinforce that chemo and immunotherapy are well tolerated in resectable stages. With robust EFS and overall survival data, this treatment approach should be discussed and proposed to patients, particularly those with stage III disease.