First-Line Selpercatinib or Chemotherapy and Pembrolizumab in RET Fusion–Positive NSCLC

作者：Caicun Zhou, Benjamin J. Solomon, Herbert Ho-Fung Loong, Keunchil Park, Maurice Pérol, Edurne Arriola, Silvia Novello, Baohui Han, Jianying Zhou, Andrea Ardizzoni, M. Perez Mak, Fernando Costa Santini, Yasir Y. Elamin, Alexander Edward Dela Cruz Drilon, Jürgen Wolf, Nalin Payakachat, Minji Kim Uh, Deborah Rajakumar, Hongmei Han, Tarun Puri, Victoria Soldatenkova, Aimee Bence Lin, Boris Kin Lin, Kōichi Goto · 发表于：New England Journal of Medicine · 年份：2023 · DOI：10.1056/nejmoa2309457 · 被引用次数：233 · 研究领域：Cancer Immunotherapy and Biomarkers、Lung Cancer Diagnosis and Treatment、Lung Cancer Treatments and Mutations

BACKGROUND: fusion-positive non-small-cell lung cancer (NSCLC) in a nonrandomized phase 1-2 study. METHODS: In a randomized phase 3 trial, we evaluated the efficacy and safety of first-line selpercatinib as compared with control treatment that consisted of platinum-based chemotherapy with or without pembrolizumab at the investigator's discretion. The primary end point was progression-free survival assessed by blinded independent central review in both the intention-to-treat-pembrolizumab population (i.e., patients whose physicians had planned to treat them with pembrolizumab in the event that they were assigned to the control group) and the overall intention-to-treat population. Crossover from the control group to the selpercatinib group was allowed if disease progression as assessed by blinded independent central review occurred during receipt of control treatment. RESULTS: In total, 212 patients underwent randomization in the intention-to-treat-pembrolizumab population. At the time of the preplanned interim efficacy analysis, median progression-free survival was 24.8 months (95% confidence interval [CI], 16.9 to not estimable) with selpercatinib and 11.2 months (95% CI, 8.8 to 16.8) with control treatment (hazard ratio for progression or death, 0.46; 95% CI, 0.31 to 0.70; P<0.001). The percentage of patients with an objective response was 84% (95% CI, 76 to 90) with selpercatinib and 65% (95% CI, 54 to 75) with control treatment. The cause-specific hazard ratio for the time...