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Jinjiang Lian
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MA05 - Update on Clinical Trials and Treatments (ID 123)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:Seiki Hasegawa, Enrico Ruffini, Angel Artal
- Coordinates: 9/08/2019, 13:30 - 15:00, Melbourne (1991)
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MA05.10 - Pembrolizumab in the Treatment of Patients with Malignant Pleural Mesothelioma Following Progression After Initial Chemotherapy (Now Available) (ID 2788)
13:30 - 15:00 | Author(s): Jinjiang Lian
- Abstract
- Presentation
Background
Checkpoint inhibitor (CPI) therapies have demonstrated clinical benefit in patients (pts) with malignant pleural mesothelioma (MPM) and are now included in the NCCN guidelines as an acceptable treatment option. Herein, we report our initial experience treating pts with MPM in the palliative second line or greater setting.
Method
Between January 2016 and November 2018, 74 pts with biopsy proven MPM were treated with pembrolizumab every three weeks until confirmed disease progression or unacceptable toxicity. Progression-free survival (PFS) and OS were defined as the time from first pembrolizumab dose to recurrence and death, respectively, or to last contact. Response rates (RR) were measured by a dedicated thoracic radiologist using modified RECIST 1.1 criteria. Adverse events were routinely recorded/scored at each follow up visit. according to CTCAE 4.0 with level of attribution to pembrolizumab.
Result
Demographics of the 74 pt cohort are shown in table 1. Twently-nine (39%) of pts experienceda total of 39 grade 1-2 adverse events, possibly or definitely related to therapy (Table 2). There was one grade 4pneumonitis that resulted in new requirement for oxygen, which resolved with steroids; and one patient experienced leukoencephalopathy that resulted in death. The overall response rate (including only partial responses by modified RECIST 1.1) for the entire cohort was 26%. Median progression free survival and overall survival for the entire cohort were 2.8 months and 7.9 months, respectively.
Table 2: Adverse Events
CTCAE 4.0 Grade
AE Description
1-2
3-4
5
hypothroid
5
arthralgias
8
colitis
3
diarrhea
2
lip lesion
1
pneumonitis
2
1
SICCA syndrome
1
thrombocytopenia
1
dermatitis
1
hypopigmentation
1
nephritis
1
fatigue
1
abdominal pain
1
uveitis
1
transaminitis
1
elvated alk phos
1
leukoencephalopathy
1
pruritis
3
hypercalcemia
3
rash
2
Table 1: Demographics
Age in Years
median (range)
Min
73
(52-92)
Gender
Patients (N=74)
Female
29
39%
Male
55
74%
Histology
Epithelial
58
78%
Sarcomatoid
6
8%
Biphasic
10
14%
# of chemotherapy courses
0
3
4%
1
42
57%
2
22
30%
3-4
7
9%
# of radiotherapy courses
0
42
57%
1
30
41%
2-3
6
8%
Surgical Resection
Have EPD
24
32%
Did not have EPD
50
68%
PDL1
Negative
21
28%
Positive
12
16%
Not Determined
42
57%
Pembrolizumab in the Tx of MPM was reasonably well tolerated in this large, single institution experience. RR, PFS and OS appear remarkably similar to recent published data from a registry study of off-label use of pembrolizumab in pts with MPM in Switzerland and Australia (include reference). Ongoing studies include analysis of PDL-1 and other potential immunotherapy response biomarkers.
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