Non-small cell lung cancer is a hard disease to treat. A newer immunotherapy drug developed by Merck & Co and called Keytruda—which activates a patient’s immune system to fight the disease—has been shown in a clinical trial to stop the disease’s progression for a longer period of time than does standard chemotherapy treatment, but only in a select group of patients with certain biomarkers. A smaller clinical trial that gave patients (without biomarkers) both drug and chemotherapy treatments and also shrank tumors and slowed disease progression is heralded as the first to demonstrate the relative efficacy of that combination.
This Reuters story shares this good news but didn’t explain the specifics: That Keytruda halted cancer progression by only about four months compared to the chemo group. It also didn’t state how much those extra months will impact the patient–financially and in quality of life; adverse events in the trials are glossed over.
Lastly, its “new day” headline and overall optimistic tone may mislead some people into thinking the drug offers lengthy survival (or even a cure) for anyone with this type of often-lethal cancer; instead this reference is to the fact that patients will now get tested for certain genetic biomarkers to see if immunotherapy is the better targeted therapy. How many people with this type of cancer have these biomarkers–and will therefore benefit–isn’t stated.
[Editor’s note: Some of the concerns with this story are recurring ones we’ve seen in both news releases and news articles on immunotherapy drugs. They are discussed in more detail in our tips for writing accurately about cancer immunotherapy drugs.]
The desperation of cancer patients with few treatment options makes them highly sensitive to any information that hints at possible treatments. These positive drug trials may be good news to someone measuring life in months, but they need as much context as a writer can provide to help patients and their doctors evaluate options.
Cost is not discussed, even though the FDA approved Keytruda for advanced, non-small cell lung cancer treatment in 2015.
The story summarizes findings of clinical study results, all of them positive. But what is a reader to make of relative risk claims such as the treatment “halved the risk of disease progression and cut overall deaths by 40%” compared to standard chemotherapy treatment? What does this mean in actual terms?
One story disseminated by Targeted Oncology and also apparently stemming from the Copenhagen oncology conference where these results were reported, noted that the “estimated 6-month overall survival (OS) rate was 80.2% with pembrolizumab (Keytruda) versus 72.4% with chemotherapy.” And when it came to risk of disease progression, the median “length of progression-free survival was 10.3 months with pembrolizumab versus 6.0 months with chemotherapy.”
Both chemotherapy and immunotherapy carry risks. But the story doesn’t discuss the general potential harms of either, nor what was reported in the study.
As the NEJM study offered up, “serious treatment-related adverse events occurred in a similar percentage of patients in the pembrolizumab (Keytruda) group and the chemotherapy group (21.4% and 20.7%, respectively).” And, “discontinuation of treatment because of treatment-related adverse events occurred in 7.1% of patients in the pembrolizumab group and in 10.7% of patients in the chemotherapy group.”
These serious adverse events included diarrhea and pneumonitis in the Keytruda group, and anemia, fatigue, and decreased appetite in the chemo group (among other events).
Some independent commentary on how these drugs impact quality of life–especially for very sick patients with advanced cancer–would have been very useful.
The story does note that these results stem from clinical trials. But the text provides few details about the size of the trials or about their design or limitations.
For example, study participants were pre-screened and had to meet the criteria of having previously untreated non-small cell lung cancer along with several very specific genetic characteristics, such as “PD-L1 expression on at least 50% of tumor cells.” What percentage of patients meet these criteria in general is not given.
This story did not disease monger. Non-small cell lung cancer is an often lethal disease.
This story just barely scores a Satisfactory rating on this one. It is clear that Merck & Co. is funding this research. A couple of sources are overtly linked to the company. A third, Dr. Stefan Zimmerman, appears to be independent, though he wasn’t quoted saying anything that helped illuminate the findings, instead he’s quoted as saying “Remember this day. It’s a new day for lung cancer treatment.” Some additional commentary from an oncologist or a patient advocate would likely have helped put the findings in perspective.
The primary message of this story is that Keytruda is superior to standard chemotherapy, as well as to another immunotherapy drug, marketed by Bristol-Myers Squibb, which was also approved by the FDA in 2015.
The story says:
“U.S. regulators are expected to decide whether to approve Keytruda for first-line non-small cell lung cancer, the most common type, by Dec. 24.”
But it doesn’t explain how that’s different from it’s already approved use for advanced non-small cell lung cancer.
The story establishes that these findings reveal that immunotherapy works better when patients are prescreened for a specific genetic marker known as PD-L1, versus giving it to anyone with this type of cancer. It also explains that the smaller second trial, mixing Keytruda with chemotherapy, was “the first time that a combination of immunotherapy and chemotherapy has been shown to work in a randomized Phase II study.”
This story apparently stems from a European oncology conference and a newly published study in the New England Journal of Medicine. The resources available to journalists at the conference–news release? press conference?–are not clear. But it’s clear from the quotes in the story that at least some original reporting went into the piece.