Final analysis of a randomised trial comparing pembrolizumab versus investigator-choice chemotherapy for ipilimumab-refractory advanced melanoma. (November 2017)

• Record Type: Journal Article
• Authors: Hamid, Omid; Puzanov, Igor; Dummer, Reinhard; Schachter, Jacob; Daud, Adil; Schadendorf, Dirk; Blank, Christian; Cranmer, Lee D.; Robert, Caroline; Pavlick, Anna C.; Gonzalez, Rene; Hodi, F. Stephen; Ascierto, Paolo A.; Salama, April K.S.; Margolin, Kim A.; Gangadhar, Tara C.; Wei, Ziwen; Ebbinghaus, Scot; Ibrahim, Nageatte; Ribas, Antoni
• Is Part Of: European journal of cancer. Volume 86(2017)
• Page Start: 37
• Page End: 45
• Publication Date: 2017-11
• Subjects: Melanoma -- Programmed cell death-1 -- PD-L1 -- Ipilimumab-refractory -- Survival; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2017.07.022
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Aim: To evaluate the protocol-specified final analysis of overall survival (OS) in the KEYNOTE-002 study (NCT01704287 ) of pembrolizumab versus chemotherapy in patients with ipilimumab-refractory, advanced melanoma. Methods: In this randomised, phase II study, eligible patients had advanced melanoma with documented progression after two or more ipilimumab doses, previous BRAF or MEK inhibitor or both, if BRAF V600 mutant-positive. Patients were randomised to pembrolizumab 2 mg/kg or 10 mg/kg every 3 weeks or investigator-choice chemotherapy. Crossover to pembrolizumab was allowed following progression on chemotherapy. The protocol-specified final OS was performed in the intent-to-treat population. Survival was positive if p < 0.01 in one pembrolizumab arm. Results: A total of 180 patients were randomised to pembrolizumab 2 mg/kg, 181 to pembrolizumab 10 mg/kg and 179 to chemotherapy. At a median follow-up of 28 months (range 24.1–35.5), 368 patients died and 98 (55%) crossed over to pembrolizumab. Pembrolizumab 2 mg/kg (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.67–1.10, p = 0.117) and 10 mg/kg (0.74, 0.57–0.96, p = 0.011) resulted in a non-statistically significant improvement in OS versus chemotherapy; median OS was 13.4 (95% CI 11.0–16.4) and 14.7 (95% CI 11.3–19.5), respectively, versus 11.0 months (95% CI 8.9–13.8), with limited improvement after censoring for crossover. Two-year survival rates were 36% and 38%, versus 30%. Progression-free survival, objective response rate and duration of response improved with pembrolizumab versus chemotherapy, regardless of dose. Grade III–V treatment-related adverse events occurred in 24 (13.5%), 30 (16.8%) and 45 (26.3%) patients, respectively. Conclusion: Improvement in OS with pembrolizumab was not statistically significant at either dose versus chemotherapy. Highlights: Improvement in overall survival with pembrolizumab versus chemotherapy in advanced melanoma not significant. Significant progression-free survival benefit, durable response and lower high-grade treatment-related adverse events. Together, data support pembrolizumab as a standard-of-care for advanced melanoma.