IOB Institute of Oncology, Quiron Group & Vall d´Hebron Institute of Oncology (VHIO), Madrid & Barcelona, Spain
Javier Cortes , David W. Cescon , Hope S. Rugo , Zbigniew Nowecki , Seock-Ah Im , Mastura Md Yusof , Carlos Gallardo , Oleg Lipatov , Carlos Henrique Barrios , Esther Holgado , Hiroji Iwata , Norikazu Masuda , Marco Torregroza Otero , Erhan Gokmen , Sherene Loi , Zifang Guo , Jing Zhao , Gursel Aktan , Vassiliki Karantza , Peter Schmid
Background: Pembrolizumab (pembro) monotherapy showed promising antitumor activity and manageable safety in patients (pts) with metastatic TNBC in KEYNOTE-012, -086 and -119. KEYNOTE-355 (ClinicalTrials.gov, NCT02819518) compared pembro + chemotherapy (chemo) vs placebo (pbo) + chemo for previously untreated locally recurrent inoperable or metastatic TNBC. Methods: Pts with ≥6 mo DFI were randomized 2:1 to pembro + chemo (nab-paclitaxel; paclitaxel; or gemcitabine/carboplatin) or pbo + chemo for up to 35 administrations of pembro/pbo or until progression/intolerable toxicity. Pts were stratified by chemo type (taxane vs gemcitabine/carboplatin), PD-L1 status (CPS ≥1 vs <1), and prior (neo)adjuvant treatment with same-class chemo (yes vs no). Dual primary endpoints are PFS (RECIST v1.1, blinded independent central review) and OS by tumor PD-L1 expression (CPS ≥10 and ≥1) and in all pts. PFS was estimated using the Kaplan-Meier method. Stratified log-rank tests were used to assess treatment group differences. HR and 95% CIs were based on a stratified Cox regression model. AEs were monitored throughout the study and graded per NCI CTCAE v4.0. Results: As of Dec 11 2019, median follow-up was 17.5 mo for pembro + chemo (n=566) and 15.5 mo for chemo (n=281). Pembro + chemo significantly improved PFS vs chemo alone in pts with CPS ≥10 tumors (Table), meeting one of the protocol-defined primary objectives. Although the boundary for a statistically significant benefit of pembro + chemo in pts with CPS ≥1 tumors was not met and formal testing in ITT was not performed, the pembro treatment effect increased with PD-L1 enrichment (Table). OS follow-up is ongoing. Grade 3-5 treatment-related AE rates were 68.1% with pembro + chemo (2 deaths) vs 66.9% with chemo (0 deaths); rates of grade 3-4 immune-mediated AEs and infusion reactions were 5.5% vs 0%. Clinical trial information: NCT02819518. Conclusion: Pembro combined with several chemo partners showed a statistically significant and clinically meaningful improvement in PFS vs chemo alone in pts with previously untreated locally recurrent inoperable or metastatic TNBC whose tumors expressed PD-L1 (CPS ≥10). Pembro + chemo was generally well tolerated, with no new safety concerns.
Population | Treatment | Median PFS, mo | HR (95% CI) | P-value | P-value boundary |
---|---|---|---|---|---|
CPS ≥10 | P + C (n=220) vs C (n=103) | 9.7 vs 5.6 | 0.65 (0.49-0.86) | 0.0012 | 0.00411 |
CPS ≥1 | P + C (n=425) vs C (n=211) | 7.6 vs 5.6 | 0.74 (0.61-0.90) | 0.0014 | 0.00111 |
ITT | P + C (n=566) vs C (n=281) | 7.5 vs 5.6 | 0.82 (0.69-0.97) | - | n/a |
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Abstract Disclosures
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