26P - Pembrolizumab (pembro) for relapsed malignant pleural mesothelioma (MPM) – outcomes in real-life setting in Australia (AUS) and Switzerland (CH) (26P)

Date 08 December 2017
Event ESMO Immuno-Oncology Congress 2017
Session Lunch & Poster Display session
Topics Oesophageal Cancer
Gastric Cancer
Gastrointestinal Cancers
Personalised Medicine
Presenter Laetitia Mauti
Citation Annals of Oncology (2017) 28 (suppl_11): xi6-xi29. 10.1093/annonc/mdx711
Authors L. Mauti1, G. Rivalland2, D. Klingbiel3, S. Kao4, S. Schmid5, A. Nowak6, O. Gautschi7, B. Hughes8, T. Bartnick9, N. Pavlakis10, H. Bouchaab11, K. O'Byrne12, S. Rothschild13, P. Russell14, S. Savic Prince15, B. Thapa16, M. Pless1, R. von Moos17, Y. Metaxas17, T. John2
  • 1Medizinische Onkologie, Kantonsspital Winterthur, 8401 - Winterthur/CH
  • 2Cancer Immunobiology Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne/AU
  • 3Sakk, Coordinating Center, Bern/CH
  • 4Medical Oncology, Chris O'Brien Lifehouse, Camperdown/AU
  • 5Medizinische Onkologie, Kantonsspital St. Gallen, 9007 - St. Gallen/CH
  • 6National Centre For Asbestos Related Diseases, University of Western Australia, Perth/AU
  • 7Medizinische Onkologie, Luzerner Kantonsspital, 6004 - Luzern/CH
  • 8Cancer Care Services, The Royal Brisbane and Women's Hospital, Brisbane/AU
  • 9Medizinische Onkologie, Kantonsspital Baden, 5404 - Baden/CH
  • 10Medical Oncology, Royal North Shore Hospital, 2065 - St Leonards/AU
  • 11Oncology, Centre Hospitalier Universitaire Vaudois - CHUV, 1011 - Lausanne/CH
  • 12Oncology, Princess Alexandra Hospital, 4102 - Woolloongabba/AU
  • 13Medizinische Onkologie, Universitätsspital Basel, 4031 - Basel/CH
  • 14Pathology, St Vincent’s Hospital, Melbourne/AU
  • 15Pathology, University Hospital Basel, 4031 - Basel/CH
  • 16Cancer Immunobiology Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne/AU
  • 17Medizinische Onkologie, Kantonsspital Graubünden, 8000 - Chur/CH

Abstract

Background

There is no approved second line treatment for MPM, and chemotherapy used in this setting (vinorelbine, gemcitabine) has limited efficacy. Based on promising early results of the phase Ib KEYNOTE-028 trial, pembro has been used off-label in CH and AUS. Outcomes from patients receiving pembro for MPM outside a clinical trial have been reported independently from AUS and CH cohorts, but conclusions were hampered by small numbers. Here we report on the combined and extended analyses from both cohorts.

Methods

Data from respective registries on pembro for relapsed MPM or patients unable to receive chemotherapy in AUS and CH were pooled. Patient characteristics, including age, gender, histology and previous treatments were entered into separate databases. Outcomes were assessed by the local investigators using standard RECIST v1.1 criteria. PD-L1 expression was determined centrally in each country and categorized as negative (

Results

A total of 95 patients were treated (48 from CH, 47 from AUS). Median age was 67.8 years (range, 25-94). The majority of patients (73%) had epithelioid MPM. Sixty-seven patients (72%) were ECOG performance status of 0-1. Pembro was used as second line treatment in 48 patients (51%). PD-L1 results were available for 67 patients (71%). Most were PD-L1 negative (67%), while 18% were intermediate and 15% were PD-L1 high. In the full cohort, the ORR was 19%, median PFS (mPFS) 3.1 months and mOS 7.2 months. In patients with ECOG 0-1 and only one previous systemic treatment (n = 35), the ORR was 37%, with a mPFS of 4.4 months and a mOS of 10.2 months. PD-L1 expression ≥5% was associated with non-epithelioid histology (p = 0.003), and with higher ORR (46%) and longer mPFS (5.6 months).

Conclusions

Compared to reported outcomes in early phase trials, PFS and OS in this real-life cohort were inferior. However, patients with good PS (0-1) and receiving pembro as second line therapy achieved better outcomes. Despite enriching for non-epithelioid histology, PD-L1 positivity was associated with improved ORR and PFS. Details on outcomes in subgroups by histology and PD-L1 expression will be presented at the meeting.

Clinical trial identification

Legal entity responsible for the study

Yannis Metaxas, Thomas

Funding

Krebsliga Graubünden, Switzerland Academic Funds, Australia

Disclosure

L. Mauti: Advisory boards for MSD, BMS, Pfizer, Roche, AstraZeneca. S. Kao: Honoraria: BMS, Roche, Astra-Zeneca; Research Funding: MSD; Travel expenses: BMS, Boehringer Ingelheim, AstraZeneca. B. Hughes: Consulting/Advisory role: MSD, Roche, BMS; Travel expenses: MSD. N. Pavlakis: Honoraria: Specialized Therapeutics, Pfizer, Novartis, Amgen, Bayer, Boehringer Ingelheim, Roche, Merck-Serono, AstraZeneca; Consulting/Advisory role: Specialized Therapeutics, Pfizer, Novartis, Amgen, Bayer, Boehringer Ingelheim, Roche, Sanofi-Aventis, Merck-Serono, AstraZeneca. K. O'Byrne: Honoraria: MSD, BMS, Roche Genentech, Boehringer Ingelheim, AstraZeneca; Consulting/Advisory role: MSD, BMS, Roche Genentech, Boehringer Ingelheim, AstraZeneca; Speaker’s Bureau: MSD, BMS, Roche Genentech, Boehringer Ingelheim, AstraZeneca; Travel expenses: MSD, BMS, Boehringer Ingelheim, AstraZeneca. S. Rothschild: Honoraries (to the institution) for advisory boards of MSD. S. Savic Prince: MSD: participation in advisory boards and speakers honoraria. M. Pless, R. von Moos: MSD: advisory board. T. John: Honoraria: Pfizer, BMS, Roche, Astra-Zeneca, Novartis. All other authors have declared no conflicts of interest.