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Pembrolizumab as first-line therapy for patients with PD-L1-positive advanced non-small cell lung cancer: a phase 1 trial.


ABSTRACT: Background:Pembrolizumab improved survival as first- and second-line therapy compared with chemotherapy in patients with highly programmed death ligand 1 (PD-L1) expressing advanced non-small cell lung cancer (NSCLC). We report the long-term safety and clinical activity of pembrolizumab as first-line therapy for patients with advanced NSCLC and the correlation between PD-L1 expression and efficacy. Patients and methods:In the open-label phase 1b KEYNOTE-001 trial, treatment-naive patients with advanced NSCLC whose tumors expressed PD-L1 (?1% staining, assessed using a prototype assay) were randomly assigned to intravenous pembrolizumab 2 or 10?mg/kg every 3 (Q3W) or 2 (Q2W) weeks. Response was assessed per central RECIST v1.1 every 9 weeks in all patients who received??1 pembrolizumab dose. Using pre-treatment tumor tissue, a clinical assay quantified the percentage of tumor cells expressing PD-L1 as tumor proportion score (TPS). Results:Between 1 March 2013 and 18 September 2015, 101 patients received pembrolizumab 2?mg/kg Q3W (n?=?6), 10?mg/kg Q3W (n?=?49), or 10?mg/kg Q2W (n?=?46). Of these, 27 (26.7%) had TPS??50%, 52 (51.5%) had TPS 1%-49%, and 12 (11.9%) had TPS?<1%. The objective response rate (ORR) was 27% (27/101, 95% CI 18-37) and median overall survival was 22.1 months (95% CI 17.1-27.2). In patients with PD-L1 TPS??50%, ORR, 12-month PFS, and 12-month OS were higher [14/27 (51.9%; 95% CI 32%-71%), 54%, and 85%, respectively] than the overall population [27/101 (26.7%; 95% CI 18.4%-36.5%), 35%, 71%]. Pembrolizumab was well tolerated, with only 12 (11.9%) patients experiencing grade 3/4 treatment-related adverse events and no treatment-related deaths. Conclusions:Pembrolizumab provides promising long-term OS benefit with a manageable safety profile for PD-L1-expressing treatment-naive advanced NSCLC, with greatest efficacy observed in patients with TPS??50%. Clinical trial name and number:KEYNOTE-001 (ClinicalTrials.gov, NCT01295827).

SUBMITTER: Hui R 

PROVIDER: S-EPMC6354672 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Pembrolizumab as first-line therapy for patients with PD-L1-positive advanced non-small cell lung cancer: a phase 1 trial.

Hui R R   Garon E B EB   Goldman J W JW   Leighl N B NB   Hellmann M D MD   Patnaik A A   Gandhi L L   Eder J P JP   Ahn M-J MJ   Horn L L   Felip E E   Carcereny E E   Rangwala R R   Lubiniecki G M GM   Zhang J J   Emancipator K K   Roach C C   Rizvi N A NA  

Annals of oncology : official journal of the European Society for Medical Oncology 20170401 4


<h4>Background</h4>Pembrolizumab improved survival as first- and second-line therapy compared with chemotherapy in patients with highly programmed death ligand 1 (PD-L1) expressing advanced non-small cell lung cancer (NSCLC). We report the long-term safety and clinical activity of pembrolizumab as first-line therapy for patients with advanced NSCLC and the correlation between PD-L1 expression and efficacy.<h4>Patients and methods</h4>In the open-label phase 1b KEYNOTE-001 trial, treatment-naive  ...[more]

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