FDA Approval Summary: Pembrolizumab, Atezolizumab, and Cemiplimab-rwlc as Single Agents for First-Line Treatment of Advanced/Metastatic PD-L1–High NSCLC

Abstract

FDA’s approval of cemiplimab-rwlc on February 22, 2021, follows prior approvals of pembrolizumab and atezolizumab for similar indications as first-line treatment for patients with programmed death ligand-1 (PD-L1)–high advanced non–small cell lung cancer (NSCLC). Approvals of these anti–PD-L1 agents were supported by statistically significant and clinically meaningful improvements in overall survival (OS) in international, multicenter, active-controlled randomized trials. In KEYNOTE-024, the OS HR was 0.60 [95% confidence interval (CI), 0.41–0.89; P ¼ 0.005] favoring pembrolizumab over platinum-doublet chemotherapy. In IMpower110, the OS HR was 0.59 (95% CI, 0.40–0.89; P ¼ 0.0106) favoring atezolizumab over platinum-doublet chemotherapy. In Study 1624, the OS HR was 0.68 (95% CI, 0.53–0.87; P ¼ 0.0022) favoring cemiplimab-rwlc over platinum-doublet chemotherapy. The progression-free survival (PFS) effect sizes for these anti–PDL1 antibodies were also comparable across their respective registrational trials, and their safety profiles were consistent with the anti–PD-L1 class adverse event profile. The consistent survival benefits and manageable toxicity profiles of these single-agent anti–PD-L1 antibodies have established them as important treatment options in the PD-L1–high NSCLC treatment landscape. FDA approvals of these anti–PD-L1 antibodies, based on their favorable benefit-risk profiles, present effective chemotherapy-free therapeutic options for patients with advanced PD-L1–high NSCLC in the United States.