Relapsed malignant pleural mesothelioma: pembrolizumab disappoints

  • Popat S & al.
  • Ann Oncol
  • 22 Sep 2020

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Pembrolizumab offered a significantly better objective response rate (ORR) than chemotherapy for patients with relapsed malignant pleural mesothelioma (MPM), but yielded no survival benefit.

Why this matters

  • Single-agent chemotherapy is the standard of care for patients with MPM who experience relapse after platinum-based chemotherapy, but previous studies of immune checkpoint inhibitors had produced promising findings.

Study design

  • International, randomized phase 3 PROMISE-meso trial.
  • 144 patients with relapsed MPM received pembrolizumab (n=73) or chemotherapy (n=71).
  • Funding: Merck, Sharpe & Dohme; Swiss Group for Clinical Cancer Research; others.

Key results

  • All patients had received prior platinum-pemetrexed chemotherapy.
  • ORR was significantly better with pembrolizumab (22% vs 6%; P=.004).
  • At a median follow-up of 11.8 months, 88.9% in the pembrolizumab group and 92.9% in the chemotherapy group had discontinued treatment.
  • No difference between groups in median PFS:
    • 2.5 months for pembrolizumab vs 3.4 months for chemotherapy.
    • HR, 1.06 (P=.76).
  • Mortality was 65.8% in the pembrolizumab group vs 62.0% in the chemotherapy group.
  • No difference between groups in median OS:
    • 10.7 months for pembrolizumab vs 12.4 months with chemotherapy.
    • HR, 1.12 (P=.59).
  • No difference between groups in OS or PFS based on programmed death-ligand 1 expression.

Limitations

  • Open-label trial.