LBA32_PR - Pembrolizumab (pembro) as first-line therapy for advanced/unresectable or metastatic urothelial cancer: Preliminary results from the phase 2 KEYNOT...

Date 08 October 2016
Event ESMO 2016 Congress
Session Genitourinary tumours, non-prostate
Topics Urothelial Cancers
Presenter Arjun Balar
Citation Annals of Oncology (2016) 27 (6): 1-36. 10.1093/annonc/mdw435
Authors A. Balar1, J. Bellmunt2, P.H. O'Donnell3, D. Castellano4, P. Grivas5, J. Vuky6, T. Powles7, E.R. Plimack8, N.M. Hahn9, R. de Wit10, L. Pang11, M.J. Savage12, R. Perini13, S. Keefe14, D. Bajorin15
  • 1Medical Oncology, Perlmutter Cancer Center, NYU Langone Medical Center, 10016 - New York/US
  • 2Medical Oncology, Dana-Farber Cancer Institute, 02215 - Boston/US
  • 3Dept. Of Medicine, The University of Chicago Medical Centre, 60637-1470 - Chicago/US
  • 4Medical Oncology, Hospital Universitario 12 de Octubre, Madrid/ES
  • 5Hematology/oncology, Cleveland Clinic, 44195 - Cleveland/US
  • 6Hematology And Oncology, Oregon Health Sciences University, Portland/US
  • 7Genitourinary Oncology, Barts Cancer Institute, Queen Mary University of London, London/GB
  • 8Department Of Hematology/oncology, Fox Chase Cancer Center, PA 19111-2497 - Philadelphia/US
  • 9Oncology And Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore/US
  • 10Medical Oncology, Erasmus MC Cancer Institute, 3075EA - Rotterdam/NL
  • 11Bards Late Development Statistics, Merck & Co., Inc., Kenilworth/US
  • 12Companion Diagnostics, Merck & Co., Inc., Kenilworth/US
  • 13Medical Oncology, Merck & Co., Inc., Kenilworth/US
  • 14Clinical Research & Development, Merck & Co., Inc., Kenilworth/US
  • 15Medicine, Memorial Sloan Kettering Cancer Center, New York/US

Abstract

Background

KEYNOTE-052 (NCT02335424), an open-label, multicenter, phase 2 study, evaluated the efficacy and safety of pembro in first-line cisplatin-ineligible pts with u/m UC.

Methods

374 pts have been enrolled. Eligibility included pathologically confirmed and measurable u/m UC, age ≥18 y, no chemotherapy for u/m disease, ECOG PS 0-2, and cisplatin ineligibility (ECOG PS 2, creatinine clearance

Results

Median age was 75 years (13% ≥85). 13% received perioperative chemotherapy. 87% had visceral disease. 46% were ECOG 2/3. 45% were cisplatin ineligible because of renal insufficiency only. 11% were cisplatin ineligible because of ECOG 2 performance status and renal insufficiency. The CPS-high cutpoint was determined to be ≥10% PD-L1 expression. As of 6/1/16, data cutoff (median 8 mo follow-up), ORR was as follows:

% (95% CI) All subjects N = 100 CPS ≥1% N = 63 CPS ≥10% N = 30
ORR 24.0 (16.0-33.6) 25.4 (15.3-37.9) 36.7 (19.9-56.1)
CR 6.0 (2.2-12.6) 6.3 (1.8-15.5) 13.3 (3.8-30.7)
Median duration of response (DOR) has not been reached (range, 1.4+ - 9.8+ mo). DOR rate ≥6 months was 83% (Kaplan-Meier estimate). 67% of pts experienced a drug-related adverse event (DRAE), most commonly fatigue (14%). 16% experienced a grade 3/4 DRAE. 5% discontinued therapy because of a DRAE.

Conclusions

Pembro 200 mg Q3W demonstrates substantial antitumor activity and has a manageable toxicity profile in cisplatin-ineligible pts with u/m UC. CPS high cutpoint was determined to be ≥10% PD-L1 expression. CR rate of 6% for all pts and 13.3% for pts CPS ≥10% is encouraging.

Clinical trial identification

NCT02335424

Legal entity responsible for the study

Merck & Co. Inc.

Funding

Merck & Co., Inc.

Disclosure

J. Bellmunt: Advisory board member for Merck, Genentech, Pfizer, Novartis, Sanofi, and Pierre Fabre, and research grants from Takeda, Novartis, and Sanofi. P.H. O'Donnell: Advisory board member for Genentech, Astra Zeneca/Medimmune, and Merck, and research grants from Genentech, Merck, and Astra Zeneca/Medimmune. P. Grivas: Advisory board member for Merck, Genentech, Bristol-Myers Squibb, Bayer, and Dendreon, and research grants from Merck, Genentech, Oncogenex, Bayer, Mirati, and Pfizer. T. Powles: Honoraria from GlaxoSmithKline, Roche, Merck, and Bristol-Myers Squibb, and research grants from Roche/Genentech. E.R. Plimack: Advisory board member for Acceleron, AstraZeneca, Bristol-Myers Squibb, Genentech/Roche, Eli Lilly Inc., Novartis, Pfizer, and Synergene, and research grants from Acceleron, AstraZeneca, Bristol-Myers Squibb, Eli Lilly Inc., Merck, and Pfizer. N.M. Hahn: Advisory board member for AZ/MedImmune, Inovio, Pieris, Genentech/Roche, Merck, BMS, and OncoGeneX, and research grants to my institution from Novartis, BMS, Heat Biologics, Merck, Genentech/Roche, AZ/MedImmune, Principia Biopharma, Mirati, and OncoGeneX. R. de Wit: Advisory board member for Sanofi, Merck, Lilly, and Roche, and research grants from Sanofi. L. Pang, R. Perini: Employee of and own stock in Merck & Co., Inc. M.J. Savage: Employee of and may own stock in Merck & Co., Inc. S. Keefe: Employee of Merck & Co., Inc. D. Bajorin: Advisory board member for Bristol-Myers Squibb, Roche, Merck, Genentech, Pfizer, and Novartis, and research grants from Roche, Merck, and Novartis. All other authors have declared no conflicts of interest.