# KEYNOTE-867: HCP commentary report

> 258 verified statements (178 from clinicians verified by NPI or staff page) from 55 commentary sources · 12 findings · updated Oct 31, 2026

## Report

- Trial: A Phase 3, Randomized, Placebo-Controlled Clinical Study to Evaluate the Safety and Efficacy of Stereotactic Body Radiotherapy (SBRT) With or Without Pembrolizumab (MK-3475) in Participants With Unresected Stages I or II Non Small Cell Lung Cancer (NSCLC) (KEYNOTE-867)
- NCT ID: NCT03924869
- Registry: https://clinicaltrials.gov/study/NCT03924869
- Sponsor: Merck Sharp & Dohme LLC
- Phase: Phase 3
- Status: Terminated
- Drugs tested: pembrolizumab
- Indication: unresected stage I/II non-small cell lung cancer
- Version: v1.0.0, edition 1
- Accepted: 2026-10-31
- Last checked: 2026-10-31
- Release hash: 4acb74440eaf5e4a596a2f749d139eb1165c464027c03d5ec32f7db85de65111

## Counts

- HCP commentary sources screened: 96
- Sources cited by verified statements: 57
- Verified statements: 258
- From speakers with a confirmed clinical role (verified by the NPI registry or their own institution's staff page): 178
- Findings: 12
- Named people in screened sources (unnamed speakers and accounts not counted): 72
- Voices cited: 72
- Cited voices identity-verified: 66
- Organisational or shared accounts (not counted as people): 5

Counts describe the retained sources. They do not estimate how many HCPs hold a view.

## Abstract

KEYNOTE-867 asks whether adding pembrolizumab to stereotactic body radiotherapy improves outcomes in unresected stage I–II non-small cell lung cancer. Commentary comes from X and LinkedIn posts and physician contributions on YouTube. Debate centers on whether pembrolizumab should be added routinely and how event-free survival should be interpreted, with the endpoint’s meaning contested. Discordant phase II and phase III findings also divide expectations for further SBRT–immunotherapy research.

## Open Medical Affairs question

What evidence would justify moving from routine restraint to a selected, tolerable systemic-treatment strategy after or around SBRT?

Raised by the leading finding. The report shows what clinicians said and the sources behind it; it does not settle the question.

## Findings (titles)

- F1. Restraint in routine immunotherapy addition is the leading clinical reading, but its scope matters
- F2. Frailty, competing mortality and strong local control explain why some clinicians would withhold additional treatment
- F3. Concurrent treatment is challenged more strongly than all possible radiation–immunotherapy sequencing
- F4. Duration is an independent concern about burden, toxicity, incentives and trial controls
- F5. Discordant phase II and phase III findings generate both methodological skepticism and continued optimism
- F6. EFS interpretation is disputed, including whether imaging changes were mistaken for progression
- F7. Selection and personalization remain open questions, including alternatives to adding IO to SBRT
- F8. Local-treatment suitability and anatomy qualify any discussion of adding systemic therapy
- F9. The result does not resolve surgery versus SBRT in fit patients, despite strong opinions about that choice
- F10. Earlier cure-optimization debates include emphatic but contested claims about dissemination and surrogate signals
- F11. Mechanistic explanations remain disputed, with exploratory alternatives rather than demonstrated rescue strategies
- F12. Access, recruitment and support for affected patients are distinct from efficacy interpretation

## What sits behind each finding

Counts describe what the report retained, not how many clinicians hold a view. A statement can support more than one finding.

| Finding | Statements | Passages | Sources | Named voices | Counterview | Limitations |
| --- | ---: | ---: | ---: | ---: | --- | ---: |
| F1 | 18 | 16 | 12 | 12 | recorded | 2 |
| F2 | 25 | 24 | 11 | 11 | recorded | 2 |
| F3 | 18 | 17 | 9 | 9 | recorded | 2 |
| F4 | 18 | 18 | 9 | 14 | recorded | 3 |
| F5 | 25 | 25 | 13 | 19 | recorded | 2 |
| F6 | 13 | 13 | 5 | 6 | recorded | 4 |
| F7 | 10 | 10 | 9 | 7 | recorded | 3 |
| F8 | 11 | 6 | 3 | 3 | none recorded | 3 |
| F9 | 31 | 25 | 7 | 13 | recorded | 3 |
| F10 | 27 | 27 | 3 | 7 | recorded | 3 |
| F11 | 21 | 20 | 6 | 10 | recorded | 3 |
| F12 | 12 | 11 | 8 | 7 | recorded | 3 |

### What the statements are

| Finding | Views | Questions and uncertainty | Clinical experience | Comparisons | Restated results and context | Passages supporting | Passages giving context | Sources by kind | Feeds the Medical Affairs question |
| --- | ---: | ---: | ---: | ---: | ---: | ---: | ---: | --- | --- |
| F1 | 12 | 2 | 0 | 2 | 2 | 19 | 1 | 9 posts and articles, 1 podcast or video, 1 publication, 1 registry | yes |
| F2 | 14 | 4 | 4 | 2 | 1 | 25 | 2 | 9 posts and articles, 2 podcasts and video | yes |
| F3 | 11 | 4 | 0 | 0 | 3 | 18 | 2 | 7 posts and articles, 1 podcast or video, 1 registry | yes |
| F4 | 7 | 5 | 0 | 2 | 4 | 19 | 1 | 8 posts and articles, 1 podcast or video | yes |
| F5 | 12 | 6 | 0 | 7 | 0 | 25 | 1 | 13 posts and articles | yes |
| F6 | 4 | 3 | 0 | 1 | 5 | 13 | 0 | 3 posts and articles, 1 podcast or video, 1 registry | yes |
| F7 | 4 | 4 | 0 | 0 | 2 | 10 | 0 | 8 posts and articles, 1 registry | yes |
| F8 | 4 | 2 | 1 | 2 | 2 | 13 | 0 | 2 posts and articles, 1 podcast or video | yes |
| F9 | 21 | 2 | 1 | 6 | 1 | 31 | 1 | 6 posts and articles, 1 podcast or video | yes |
| F10 | 10 | 5 | 1 | 2 | 9 | 29 | 0 | 3 posts and articles | yes |
| F11 | 12 | 7 | 1 | 0 | 1 | 21 | 2 | 5 posts and articles, 1 podcast or video | yes |
| F12 | 2 | 1 | 0 | 2 | 7 | 14 | 1 | 6 posts and articles, 1 podcast or video, 1 registry | yes |

### Trial dimensions

- Primary endpoint: Event-free Survival (EFS): F1 (2 shared claims), F6 (6 shared claims)
- Secondary endpoints: F1 (1 shared claims), F2 (2 shared claims), F3 (1 shared claims), F6 (1 shared claims), F9 (1 shared claims)
- Population and setting: F1 (1 shared claims), F2 (22 shared claims), F3 (1 shared claims), F7 (1 shared claims), F8 (1 shared claims), F9 (4 shared claims)
- The comparison: F1 (1 shared claims), F2 (1 shared claims), F3 (15 shared claims), F4 (13 shared claims), F5 (2 shared claims), F11 (1 shared claims), F12 (1 shared claims)
- Safety and tolerability: F1 (4 shared claims), F2 (3 shared claims), F4 (1 shared claims), F6 (1 shared claims)
- Design and conduct: F1 (6 shared claims), F3 (2 shared claims), F5 (9 shared claims), F6 (1 shared claims)

## Sample findings

Paraphrased; the full report links each statement to its source.

### F5. Discordant phase II and phase III findings generate both methodological skepticism and continued optimism

An X-thread exchange asked how KEYNOTE-867 and I-SABR differed in their trial designs.

Source: X thread, 2024-08-29.

### F6. EFS interpretation is disputed, including whether imaging changes were mistaken for progression

An X-thread exchange asked how event-free survival was defined in KEYNOTE-867 and whether that endpoint reflected routine clinical care.

Source: X thread, 2024-12-13.

## What's inside

| Section | Items | Access |
| --- | ---: | --- |
| Findings with interpretation, counterviews and limits | 12 | Titles free |
| Detailed analysis | 13 sections | Paid |
| Verified statements with short source quotes and links | 258 | Paid |
| Trial aspects mapped | 15 | Free |
| Sources with links | 57 | Counts free |
| Speaker attribution for cited voices | 72 | Paid |

## Trial aspects

15 discussed · 0 no commentary found · 0 assessment incomplete.

| Aspect | Coverage | Statements | Sources |
| --- | --- | ---: | ---: |
| Primary endpoint: Event-free Survival (EFS) | discussed | 10 | 6 |
| Secondary endpoints | discussed | 11 | 11 |
| Population and setting | discussed | 39 | 16 |
| The comparison | discussed | 29 | 13 |
| Safety and tolerability | discussed | 20 | 9 |
| Design and conduct | discussed | 27 | 21 |
| Phase II–phase III discordance and the awaited PACIFIC-4/PACIFIC-IV result | discussed | 28 | 13 |
| Duration, treatment burden and salvage-treatment controls | discussed | 18 | 9 |
| Biomarkers, residual disease risk and personalized treatment | discussed | 11 | 10 |
| Anatomy, fractionation and alternatives when SBRT is unsuitable | discussed | 11 | 3 |
| Operable treatment choices and the validity of SBRT–surgery comparisons | discussed | 31 | 7 |
| Early-stage cure optimization, dissemination and the limits of surrogate signals | discussed | 27 | 3 |
| Radiation–immune biology and exploratory combination strategies | discussed | 21 | 6 |
| Access, recruitment, affordability and support after treatment discontinuation | discussed | 11 | 7 |
| Endpoint ascertainment, clinical relevance and limits of further planned evidence | discussed | 8 | 4 |

An aspect marked incomplete is a question the public commentary did not let us answer. We show it rather than hide it.

## Sources

| Channel | Screened | Cited |
| --- | ---: | ---: |
| X threads | 87 | 50 |
| LinkedIn posts | 3 | 3 |
| Bluesky threads | 4 | 0 |
| YouTube | 2 | 2 |
| Publications (primary source, cited for context) | not screened | 1 |
| Registry (primary source, cited for context) | not screened | 1 |

- Screened window: 2019-04-23 to 2026-10-30
- Cited window: 2020-04-23 to 2026-10-30
- Retrieved: 2026-10-31

Screened sources were retrieved for this trial. Cited sources back at least one verified statement and include primary sources used for context.

## The trial

From ClinicalTrials.gov.

- Title: A Phase 3, Randomized, Placebo-Controlled Clinical Study to Evaluate the Safety and Efficacy of Stereotactic Body Radiotherapy (SBRT) With or Without Pembrolizumab (MK-3475) in Participants With Unresected Stages I or II Non Small Cell Lung Cancer (NSCLC) (KEYNOTE-867)
- Registry: NCT03924869 (https://clinicaltrials.gov/study/NCT03924869)
- Study IDs: 3475-867 · MK-3475-867 (MSD) · KEYNOTE-867 (MSD) · 194909 (JAPAC-CTI) · 2022-500413-11-00 (EU CT) · U1111-1275-8515 (UTN) · 2018-004320-11
- Sponsor: Merck Sharp & Dohme LLC
- Design: Phase 3 · interventional, randomized, parallel, phase3
- Status: Terminated
- Enrollment: 448 (actual)
- Start: 2019-06-25 (actual)
- Primary completion: 2024-06-11 (actual)
- Primary endpoint: Event-free Survival (EFS) (Up to approximately 56.8 months)
- Intervention: Stereotactic Body Radiotherapy (SBRT) (radiation)
- Intervention: Pembrolizumab (biological)
- Intervention: Placebo (drug)

## Scope and limits

This report does not judge efficacy, estimate HCP prevalence or consensus or give treatment advice.

- Discussion that does not name the trial may be missing from this edition.
- Not yet captured in this edition: a remark on studying upfront alternatives to surgery to optimize cure in stage I lung cancer.
- Not yet captured in this edition: a view on uncertainty over adjuvant versus salvage immunotherapy and similar trial designs in unresected early-stage lung cancer.
- Some passages in the sources used in this report were not fully assessed for clinician views, so a view there may be missing from this edition.
- 116 statements in the sources reviewed for this edition are about other patients or topics, or only mention the trial, and are not counted.
- Further source limits: discussion that describes the trial without naming it may be incomplete; some discussion that describes the trial without naming it may be missing.
- The report describes the sources reviewed for this edition, not all public discussion or the frequency of opinions among HCPs. Trial-name-focused source selection may miss unnamed references and transcription variants.
- Some potentially relevant passages were not fully assessed. Portions of the salvage-control, treatment-duration and financial-burden discussion may contain additional reasons or qualifications not represented here.
- The account of the local-treatment dissemination exchange is incomplete, including an additional response to physiological counterarguments and uncertainty in a relayed radiation caution's attribution. A complete account of treatment choices when surgery could not proceed after neoadjuvant therapy is also unavailable.
- Many numerical results, subgroup observations and proposed explanations are reported by speakers. Detailed event adjudication, subgroup tables and full safety analyses are not available in the statements used here; these views cannot establish misclassification, a predictive subgroup or a causal mechanism.
- The primary publication passage provides a conclusion, while the protocol amendment provides an interim stopping account and revised follow-up plans. Neither justifies treating every social-post numerical or mechanistic interpretation as a primary result.
- Some speakers' identities or clinical roles are not established in the sources used in this report; each statement is attributed only as far as its source shows.
- Source descriptions of a speaker as presenting KEYNOTE-867 and another speaker as involved in KEYNOTE-867 are attributed descriptions of involvement, not evidence that their views are independent external assessments.
- Historical statements about eligibility, treatment schedules, enrollment targets and site access are preserved as dated accounts. Differences between those accounts are not silently reconciled, and post dates do not establish meeting dates or changes of mind.
- Comparisons with I-SABR, S1914, surgical studies and other radiation–immunotherapy experiences involve different regimens, populations or endpoints. They explain speakers' reasoning but do not establish comparative efficacy between those alternatives.

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## Editions and corrections

- v1.0.0, accepted 2026-10-31: current edition

Last checked for new commentary 2026-10-31. No corrections. Versions follow semver: a new or changed finding is a minor version, more evidence without a material change is a patch.

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## Cite

Erudio Health. KEYNOTE-867 (NCT03924869): HCP commentary report. Edition 1, v1.0.0. Accepted Oct 31, 2026. https://www.erudio.com/reports/keynote-867-nct03924869

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