1224PD - Analysis of response and survival in patients (pts) with ipilimumab (ipi)-refractory melanoma treated with pembrolizumab (pembro) in KEYNOTE-002

Date 11 September 2017
Event ESMO 2017 Congress
Session Melanoma and other skin tumours
Topics Cancer in Adolescents
Cancer Immunology and Immunotherapy
Melanoma and other Skin Tumours
Presenter Adil Daud
Citation Annals of Oncology (2017) 28 (suppl_5): v428-v448. 10.1093/annonc/mdx377
Authors A. Daud1, I. Puzanov2, R. Dummer3, D. Schadendorf4, O. Hamid5, C. Robert6, F..S. Hodi7, J. Schachter8, J. Sosman9, A.C. Pavlick10, R. Gonzalez11, C.U. Blank12, L. Cranmer13, S.J. O’day14, A.K. Salama15, K. Margolin16, J. Yang17, B. Homet Moreno18, N. Ibrahim18, A. Ribas19
  • 1Medical Oncology/hematology, University of California San Francisco UCSF, 94143 - San Francisco/US
  • 2Medical Oncology, Roswell Park Cancer Institute, Buffalo/US
  • 3Dermatology, University of Zurich Hospital, Zurich/CH
  • 4Department Of Dermatology - Hautklinik, University Hospital Essen Westdeutsches Tumorzentrum, 45122 - Essen/DE
  • 5Medicine, The Angeles Clinic and Research Institute, 90025 - Los Angeles/US
  • 6Department Of Medicine, Gustave Roussy and INSERM Unité 981, 94800 - Villejuif–Paris Sud/FR
  • 7Medical Oncology, Dana-Farber Cancer Institute, Boston/US
  • 8Oncology, The Ella Institute for Treatment and Research of Melanoma and Skin Cancer, Ramat Gan/IL
  • 9Department Of Medicine, Vanderbilt University, 37232-6838 - Nashville/US
  • 10Department Of Medicine, New York University, New York/US
  • 11Medicine, University of Colorado Comprehensive Cancer Centre, Aurora/US
  • 12Medical Oncology, The Netherlands Cancer Institute, 1066CX - Amsterdam/NL
  • 13Medicine, University of Washington and Seattle Cancer Care Alliance, Seattle/US
  • 14Medical Oncology, John Wayne Cancer Institute, Santa Monica/US
  • 15Medicine, Duke Cancer Institute, Durham/US
  • 16Medical Oncology, City of Hope, 91010 - Duarte/US
  • 17Biostatistics, Merck & Co., Inc., Kenilworth/US
  • 18Oncology, Merck & Co., Inc., Kenilworth/US
  • 19Medicine-hematology/oncology, University of California, Los Angeles, Los Angeles/US

Abstract

Background

Treatment with checkpoint inhibitors can result in durable responses and deepening of responses over time with conversion of SD to PR or CR, and PR to CR. In the randomized KEYNOTE-002 study (NCT01704287), pembro 2 mg/kg or 10 mg/kg improved PFS (HR 0.57 and 0.50; P

Methods

Pts were treated until disease progression (PD), unacceptable toxicity or investigator/pt decision. Response (RECIST v1.1; investigator review) was assessed at wk 12, every 6 wk until wk 48, then every 12 wk, and confirmed by subsequent scan. Survival was assessed every 12 wk during follow-up. Pembro arms were combined given no difference in efficacy of doses.

Results

As of 3 Feb 2017, median follow-up duration was 42.7 mo. In pembro-treated pts, median PFS was 4.2 mo (95% CI 3.3-5.6), and 36-mo PFS rate was 16%. Median OS was 14.0 mo (11.8-16.2), and 36-mo OS rate was 30%. 99 of 361 pts had CR (n = 29) or PR (n = 70) for ORR of 27.4% (95% CI 22.9-32.3); 88 pts had SD. Median time to response was 2.9 mo. Of 29 pts with CR, 5 converted from SD, 21 from PR. Of 70 pts with PR, 28 converted from SD. Median time from SD to PR was 2.7 mo (range 0.9-25.2), from SD to CR was 6.9 mo (3.9-21.9), and from PR to CR was 8.0 mo (1.4-25.2). Median DOR was not reached in pts with CR or PR (Table). Median duration of SD was 6.9 mo (range 0.8+ to 38.8+). 9 (31%) pts with CR, 28 (40%) with PR and 63 (72%) with SD had subsequent PD; in these pts, median duration of CR was 17.1 mo (5.5-36.1), PR 7.7 mo (2.0-31.8), and SD 5.8 mo (2.7-25.3). Median PFS and OS were longer in pts with CR or PR (Table).

Conclusions

Responses to pembro are durable and associated with prolonged OS in ipi-refractory melanoma. Even in these heavily pretreated pts best response can evolve over time, with late conversions from SD to PR/CR and PR to CR observed.Table:

1224PD

OutcomesCR (n = 29)PR (n = 70)SD (n = 88)All-treated (N = 361)
Median time to response*, mo (range)2.9 (2.4-24.9)2.9 (1.9-27.9)2.9 (1.9-27.9)
Median DOR, mo (range)NR (5.5-41.6+)NR (1.9+ to 43.5+)6.9 (0.8+ to 38.8+)NR (1.9+ to 43.5+)
Median PFS, mo (95% CI)41.0 (38.9-NR)35.8 (27.9-NR)7.0 (5.8-9.7)4.2 (3.3-5.6)
12/24/36-mo PFS rate97%/75%/72%76%/66%/49%24%/6%/1%29%/21%/16%
Median OS, mo (95% CI)NR (NR-NR)NR (NR-NR)16.5 (13.8-20.5)14.0 (11.8-16.2)
12/24/36-mo OS rate100%/93%/89%96%/86%/71%71%/31%/24%55%/37%/30%
*

Best overall response with confirmation;

Duration of SD;

Kaplan-Meier method for censored data; CI, confidence interval; NR, not reached

Clinical trial identification

mk-3475-002 ClinicalTrials.gov NCT01704287 First received: October 8, 2012 Last updated: March 28, 2017 Last verified: March 2017

Legal entity responsible for the study

Merck & Co., Inc.

Funding

Merck & Co., Inc.

Disclosure

A. Daud: Received research funding from and is an advisory board member of Merck & Co., Inc. R. Dummer: Received honoraria from MSD, Merck & Co., Inc.\'s international counterpart. D. Schadendorf: Received research, honoraria and travel funding from Merck & Co., Inc. Serves as an advisory board member and on speaker\'s bureau for Merck & Co., Inc. O. Hamid: Serves on an advisory board for and has received research funding from Merck & Co., Inc. C. Robert: Received honoraria from Merck & Co., Inc. F.S. Hodi: Advisory board member for Merck & Co., Inc. J. Schachter: Received honoraria from MSD, an international division of Merck & Co., Inc. A.C. Pavlick: Been a consultant for Merck & Co., Inc. R. Gonzalez: Received travel funding, research grants and honoraria from Merck & Co., Inc. Served as an advisory board member for Merck & Co., Inc. C.U. Blank: Served on advisory board and on speaker\'s bureau for Merck & Co., Inc. Received honoraria from Merck & Co., Inc. S.J. O’day: Received research funding for and served as an advisory board member of Merck & Co., Inc. A.K. Salama: Received research funding for and has been an advisory board member of Merck & Co., Inc. K. Margolin: Received researched funding from Merck & Co., Inc. J. Yang: Employee of Merck & Co., Inc. and may own stock options in the company. B. Homet Moreno: Employee of Merck & Co., Inc. and may own stock options in the company. N. Ibrahim: Employee of Merck & Co., Inc. and may own stock options in the company. A. Ribas: Received honoraria from Merck & Co., Inc. All other authors have declared no conflicts of interest.