For those taking
pembrolizumab, there needs to be a certain threshold of PD - L1 expressed on the tumor for treatment, according to the FDA's label.
On May 23, the Food and Drug Administration approved
pembrolizumab for cancer patients with mismatch repair mutations for whom other drugs have failed.
Treating patients with an antibody called
pembrolizumab (sold under the brand name Keytruda) caused these T cells to increase in number, says coauthor Kellie Smith, a cancer immunologist at Johns Hopkins University.
Researchers are currently testing
pembrolizumab to determine if it has the same result in other cancers, as well as trying to combine
pembrolizumab with other therapies.
The FDA also expanded the approval of
pembrolizumab to treat the majority of people with NSCLC who had received prior chemotherapy, greatly increasing the patient population that can benefit from the treatment.
Now, patients with PD - L1 expression on at least half of their cancer cells can receive
pembrolizumab prior to standard chemotherapy.
The drug, Keytruda (
pembrolizumab), was tested on more than 600 patients who had melanoma that had spread throughout their bodies.
Pembrolizumab, which is marketed under the brand name Keytruda, works by turning off the immune system's brakes, allowing its T cells to recognize and attack cancer cells.
The idea to specifically study this group of patients was based on groundbreaking research Garon published in the New England Journal of Medicine last year, which found that among patients who received
pembrolizumab, those with PD - L1 expression on at least 50 percent of their cancer cells showed the longest survival and disease control.
Dr. Glen Weiss, M.D., M.B.A., is the first author of the study abstract: Phase Ib / II Study of
Pembrolizumab plus Chemotherapy in Advanced Cancer: Results of lung cancer patients receiving (at least) 1 prior line of therapy.
Pembrolizumab, or pembro, an immunotherapy drug that unmasks cancer cells and allows the body's own immune system to help destroy tumors, appears to be safe in treating lung cancers, according to a study by Cancer Treatment Centers of America ® (CTCA) at Western Regional Medical Center (Western) in Goodyear, Arizona.
Dr. Weiss» study of
pembrolizumab was presented during a session on small cell lung cancer when the theme of the conference was Science Drives Lung Cancer Advances.
We are currently waiting for the results of several trials including EORTC 1325 which is investigating
pembrolizumab, a PD - 1 checkpoint blocking antibody, compared to placebo in the adjuvant setting.»
Response rates, overall survival and progression - free survival rates were superior in
the pembrolizumab and chemotherapy combination - treatment group.
Of those treated with
pembrolizumab and platinum + pemetrexed, the risk of death was reduced by 51 %, compared to those treated with platinum + pemetrexed alone.
«The data show that treatment with
pembrolizumab and chemotherapy together is more effective than chemotherapy alone,» says Gandhi.
Pembrolizumab and nivolumab, for example, the newest inhibitors to win FDA approval, target a checkpoint called PD - 1, through which tumors can induce a T cell to deactivate.
Since approving ipilimumab five years ago, the Food and Drug Administration has OK'd two similar drugs —
pembrolizumab and nivolumab — for melanoma and certain lung cancers.
«The objective overall response rate for the single agent
pembrolizumab was up to 35 percent, but why shouldn't more patients respond?»
In a phase 1b clinical trial with 21 patients, researchers tested the safety and efficacy of combining the immunotherapy drug
pembrolizumab with an oncolytic virus called T - VEC.
«All endpoints of efficacy and tolerability favoured treatment with
pembrolizumab, suggesting it should become one standard of care for first line treatment of patients with advanced NSCLC and high PD - L1 expression.
Patients in the chemotherapy arm who progressed were eligible to crossover to
pembrolizumab as second line treatment — this occurred in 44 % of these patients.
In Cohort A,
pembrolizumab shrunk tumors by more than 30 percent in eight of 170 patients, or five percent, and stabilized the disease in 35, or 21 percent, of those previously treated for mTNBC.
Three patients had more serious autoimmune side effects, which are sometimes seen after
pembrolizumab treatment.
The immunotherapy drug
pembrolizumab — already FDA - approved for other forms of cancer - has been found to be effective in patients with metastatic triple negative breast cancer, according to an international clinical trial led by NYU Langone's Perlmutter Cancer Center.
By injecting T - VEC into the patients» tumors, even those that were located deeper in the body, the researchers were able to transform cold tumors into hot ones, which in turn allowed
pembrolizumab to deliver a beneficial enhancement.
«Interestingly, we found that activity of
pembrolizumab was seen in both PD - L1 - positive and - negative tumors.
The investigators found that
pembrolizumab significantly improved the primary endpoint of progression - free survival by approximately four months compared to chemotherapy (10.3 months versus 6.0 months, hazard ratio [HR] 0.50).
Merck, the manufacturer of
pembrolizumab, funded this clinical trial and provided Adams and her colleagues with research support.
Pembrolizumab is set to become a new option for first line treatment of patients with advanced lung cancer and high PD - L1 expression, according to the results of the phase III KEYNOTE - 024 trial presented at the ESMO 2016 Congress in Copenhagen and published in the New England Journal of Medicine.
In Cohort B — those who received
pembrolizumab as first - line therapy — 12 of 52 patients, or 23 percent, saw tumors shrink by more than 30 percent, while the disease was stabilized in nine of them, or 17 percent.
«By causing fewer side effects and promoting longer life expectancy,
pembrolizumab could help change the outcome of mTNBC.»
Drugs like
pembrolizumab boost the response in tumors where immune cells are present but don't work in tumors where there is no immune response to boost.
«The reason KEYNOTE - 024 met its primary endpoint, in contrast with other studies, is probably because the trial only included patients who had PD - L1 expression of at least 50 % and were therefore optimal candidates for treatment with
pembrolizumab,» he added.
«Although only a small subset of women responded to the drug, within that subset
pembrolizumab worked extremely well and responses were durable,» Adams adds.
UNC Lineberger researchers are planning to launch an investigator - initiated clinical trial year to assess whether the combination denosumab with the checkpoint inhibitor
pembrolizumab is more effective than
pembrolizumab alone for treating patients with advanced melanoma.
The trial included 305 patients from 16 countries who were randomised 1:1 to
pembrolizumab or chemotherapy.
Conversely, the side effects of
pembrolizumab are much less frequent and more tolerable, says Adams.
The goals of Cohort B, for which survival data are not yet complete, were, primarily, to prove
pembrolizumab's safety and, secondarily, to explore its efficacy as a first - line treatment.
Pembrolizumab, marketed under the name Keytruda, was well tolerated by both cohorts at a 200 mg dose every three weeks, according to study results.
«The significant improvement in overall survival with
pembrolizumab was remarkable given that more than 40 % of patients crossed over from the control arm to
pembrolizumab after progression of the disease,» said Reck.
KEYNOTE - 024 investigated the efficacy of
pembrolizumab compared to standard of care with platinum - based chemotherapy in untreated patients with advanced NSCLC and high PD - L1 expression (defined as expression in at least 50 % of tumour cells).
«Immunotherapy drug effective for metastatic triple negative breast cancer:
Pembrolizumab shown to shrink tumors — regardless of whether patient had prior treatment.»
Checkpoint inhibitors like ipilimumab — which has been on the market since 2011 — nivolumab, and
pembrolizumab stop tumor cells from stimulating the receptors.
«Sixteen of these patients (19 %) responded to treatment with
pembrolizumab, of whom 12 are still alive without their disease progressing and, so far, the longest time some of these patients have continued to be successfully treated is more than 27 months,» he said.
There are some patients with mucosal melanoma who have had complete responses to
pembrolizumab and essentially return to a normal life.
These results support the use of
pembrolizumab as the new standard of care for advanced bladder cancer,» concluded Dr Necchi.
In addition to helping patients live longer, more patients treated with
pembrolizumab responded to treatment and for a longer duration than those treated with chemotherapy; the objective response rate — the percentage of patients whose tumours shrank or disappeared — was almost twice as high with
pembrolizumab: 21 % compared to 11 % on chemotherapy.
Dr Butler said: «Our results show that patients benefited from
pembrolizumab regardless of whether or not they had been pre-treated with ipilimumab.»
Clinical trials of a new immunotherapy,
pembrolizumab, have shown that it prolongs life significantly for patients with bladder cancer and is active against a rare sub-type of melanoma, called mucosal melanoma.