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J Thorac Oncol. 2018 Nov;13(11):1784-1791. doi: 10.1016/j.jtho.2018.08.007. Epub 2018 Aug 22.

Pembrolizumab as Palliative Immunotherapy in Malignant Pleural Mesothelioma.

Author information

1
Department of Medical Oncology, Cantonal Hospital Grison, Chur, Switzerland.
2
Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia.
3
Department of Medical Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
4
Swiss Group for Clinical Cancer Research Coordinating Center, University of Bern, Bern, Switzerland.
5
Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
6
Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, University of Bern, Switzerland.
7
University of Western Australia, Crawley, Western Australia, Australia; Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
8
Department of Medical Oncology, Lucerne Cantonal Hospital, Lucerne, Switzerland.
9
Department of Medical Oncology, Cantonal Hospital Baden, Baden, Switzerland.
10
Cancer Care Services, The Royal Brisbane and Women's Hospital, Queensland, Australia.
11
Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland.
12
Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.
13
Department of Medical Oncology, Royal North Shore Hospital, Sydney University, Sydney, New South Wales, Australia.
14
Department of Medical Oncology, Uster Hospital, Uster, Switzerland.
15
Department of Medical Oncology, Oncological Center Zurich, Zurich, Switzerland.
16
Princess Alexandra Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia.
17
Department of Oncology, Cantonal Hospital, Bellinzona, Switzerland.
18
Department of Oncology, Hospital St. Clara, Basel, Switzerland.
19
Department of Medical Oncology, City Hospital Waid, Zurich, Switzerland.
20
Department of Pathology, St. Vincent's Hospital, Fitzroy, Victoria, Australia.
21
Department of Medical Oncology, Solothurn Hospitals, Olten, Switzerland.
22
Department of Pathology, University Hospital Basel, Basel, Switzerland.
23
Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia. Electronic address: tom.john@onjcri.org.au.

Abstract

INTRODUCTION:

There is no approved second-line treatment for malignant pleural mesothelioma (MPM). On the basis of promising early results, pembrolizumab was used off-label in Switzerland and Australia. We investigated outcomes in association with clinicopathological features and expression of programmed death ligand 1 (PD-L1).

METHODS:

Registry data in Australia and Switzerland were pooled. Patient characteristics, including age, sex, histological subtype, and previous treatments were captured. Outcomes were assessed locally. PD-L1 expression was categorized as negative (<5%), intermediate (5%-49%), and high (≥50%).

RESULTS:

A total of 93 patients (48 from Switzerland and 45 from Australia) were treated; 68 patients (73%) had epithelioid MPM, and 67 (72%) had an Eastern Cooperative Oncology Group performance status of 0 or 1. Pembrolizumab was the second-line treatment in 48 of 93 patients (52%). PD-L1 expression results were available for 66 patients (71%). Most (68%) were negative, 18% were intermediate, and 14% were high for PD-L1 expression. In the full cohort, the overall response rate (ORR) was 18%, the median progression-free survival (mPFS) was 3.1 months, and the median overall survival was 7.2 months. In patients with an Eastern Cooperative Oncology Group performance status of 0 or 1 and only one previous systemic treatment (n = 35), the ORR was 37%, the mPFS was 3.7 months, and the median overall survival was 10.2 months. The nonepitheloid histological subtype showed an improved ORR (24% versus 16% [p = 0.54) and mPFS (5.6 versus 2.8 months [p = 0.02]). Compared with intermediate and negative PD-L1 expression, high PD-L1 expression was associated with an improved ORR (44% versus 42% versus 11% [p = 0.01]) and mPFS (6.2 versus 3.9 versus 2.7 months [p = 0.04]). Toxicity was as expected.

CONCLUSION:

These real-world data demonstrate similar response rates but inferior survival compared with those in early-phase trials. High PD-L1 expression and nonepitheloid histological subtype were associated with greater activity. Anti-PD-L1 immunotherapy is a reasonable second-line therapy in patients with MPM.

KEYWORDS:

Immunotherapy; Mesothelioma; PD-1; Pembrolizumab; Second-line therapy

PMID:
30142389
DOI:
10.1016/j.jtho.2018.08.007
[Indexed for MEDLINE]
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