A randomised open-label phase III trial of Reduced Frequency pembrolizumab immuNothErapy for first-line treatment of patients with advanced non-small cell lung cancer (NSCLC) utilising a novel multi-arm frequency-response optimisation design. 

REFINE-Lung Trial Coordinating Centre

CRUK Imperial Centre: Clinical Trials Section/ Imperial Clinical Trials Unit – Cancer
Imperial College London
Hammersmith Campus
Du Cane Road
London W12 0NN 

Tel: 020 7594 2180

Email: REFINE-Lung@imperial.ac.uk

Trial Aim

To determine the optimal continuing dose frequency of pembrolizumab amongst patients with non-small cell lung cancer (NSCLC) who have benefited from and completed 6 months of standard therapy.


Multi-centre randomised open-label, utilising novel multi-arm frequency- response optimisation



Information Sheet

REFINE-Lung information sheet

Information Video



Eligible patients with NSCLC will initially be recruited from the following centres:


Principal Investigator

Charing Cross Hospital

Joanne Evans

Weston Park Hospital, Sheffield

Fiona Taylor

Royal Surrey County Hospital

Madeleline Hewish

The Royal Marsden NHS Foundation Trust

Mary O'Brien

The Beatson West of Scotland Cancer Centre

Ishtiaq Zubairi

New Victoria Hospital, Glasgow

Nicola Steele

Guy's Hospital

James Spicer

Velindre Cancer Centre

Paul Shaw

Colchester Hospital

Dakshinamoorthy Muthukumar

Ipswich Hospital

Kent Yip

Clatterbridge Cancer Centre

Tony Pope

Bristol Haematology & Oncology Centre

Adam Dangoor

St James's Hospital, Leeds

Pooja Jain

NHS Lothian - Western General Hospital, Edinburgh

Colin Barrie

Forth Valley Royal Hospital

Nicola Steele

The Christie Hospital, Manchester

Fabio Gomes

Nottingham City Hospital

Jason Adhikaree

The Freeman Hospital, Newcastle

Sally Hall

East Kent Hospitals University NHS Foundation Trust

Mathilda Cominos

Peterborough City Hospital

Sarah Treece

Queen's Hospital, Romford

Kathryn Tarver

Leicester Royal Infirmary

Jaseela Chiramel

Birmingham Heartlands Hospital

Joyce Thompson

Royal Devon and Exeter Hospital

Petru Belitei

Royal Cornwall Hospital

Grant Stewart

Royal Derby Hospital

Manjusha Keni

Royal Sussex County Hospital, Brighton

Kam Zaki

University Hospitals Dorset NHS Foundation Trust

Tom Geldart

Kettering General Hospital

George Tsaknis

Additional centres may join the study at a later date. If you wish to take part, please speak to your oncologist.


Patients will be given an appropriate time period to consider participation (at least 24 hours). Written consent will be obtained from those patients who agree to participate and randomisation will be performed using OpenClinica eCRF. At each recruiting centre, a log of all approached and screened patients will be kept. Basic demographic data and reasons for non-eligibility will be recorded. Whilst participant baseline characteristics may vary slightly across recruiting sites, randomised treatment allocation will allow reliable assessment of the effects of reduced frequency treatment on survival rates.

Size of the trial

The trial plans to recruit 1750 patients over a 3.5 year period, initially comparing 6 and 12 weekly frequency of treatment. After interim analysis a further 3 arms will open, 9, 15 and 18 weekly frequencies.


Inclusion criteria

  1. Written informed consent prior to initiation of any study procedures and willingness and ability to comply with the study schedule
  2. Any patient ≥18yrs who has received 6 months of pembrolizumab treatment, with or without chemotherapy, for advanced NSCLC who is planned to continue / move to immunotherapy every 6 weeks because of continued benefit

Exclusion criteria

  1. Disease progression or not tolerating treatment at 6 months into therapy
  2. Clinician does not intend to continue immunotherapy
  3. Any patient currently receiving an investigational agent and/or using an investigational device or has participated in a study of an investigational agent and/or used an investigational device within 28 days of randomisation.


This project was funded by the National Institute for Health Research (NIHR HTA) Programme (NIHR133011).