Most Read Articles
Christina Lau, 20 Apr 2020

Hippocampal avoidance during whole-brain radiotherapy (HA-WBRT), together with memantine, better preserves cognitive function vs WBRT plus memantine in patients with brain metastases, without compromising survival, a multi-institutional phase III trial has shown.

Natalia Reoutova, 20 May 2020

Cancer patients infected with coronavirus disease 2019 (COVID-19) appear to be at higher risk of severe outcomes, including death, but cancer type and treatment serve as better predictors, according to recent research presented at the American Association for Cancer Research (AACR) 2020 Virtual Annual Meeting I.

At the time of writing, COVID-19 has spread to more than 200 countries and territories, affecting an estimated 4.5 million people and killing over 300,000. Cancer, on the other hand, is newly diagnosed in 18 million people and takes the lives of 10 million every year.

“We have invited physician scientists who are at the epicentre of the COVID-19 pandemic, taking care of patients with cancer. They gathered prospective information to understand the effects of COVID-19 on patients with cancer, are testing new treatments, and are making this knowledge available to the global research community, so we can all benefit from their experience,” said Professor Antoni Ribas from UCLA Medical Center, Los Angeles, California, US, chairperson of the COVID-19 and cancer plenary session of the meeting.

4 days ago
Case presentation: The patient is a 46-year-old Korean lady who first presented with aggravating pleuritic chest pain characterised by a stabbing pain in the chest when inhaling and exhaling. A diagnosis of non-small cell lung cancer (NSCLC) was made from computed tomography (CT)-guided needle aspiration biopsy, and the tumour was found to be epidermal growth factor receptor (EGFR) mutation-positive (exon 19 deletion). Chest imaging revealed the presence of left-sided pleural seeding nodules. The patient was treated with afatanib with partial response as best response. Ten months after starting treatment, the patient experienced disease progression.

Two studies highlight potential of third-line pembrolizumab in advanced SCLC

Roshini Claire Anthony
30 Apr 2019

Patients with advanced small cell lung cancer (SCLC) who experience disease progression despite two or more lines of therapy could benefit from pembrolizumab in the third-line setting, according to results from the phase 1b KEYNOTE-028 and phase II KEYNOTE-158* studies presented at AACR 2019.

Despite the first- and second-line therapies available for advanced SCLC, the 5-year survival rate for this condition is poor at <10 percent, said study author Professor Hyun Cheol Chung from the Yonsei Cancer Center, Seoul, Republic of Korea.

“Our findings show that pembrolizumab monotherapy can provide promising antitumour activity with durable clinical benefit and manageable toxicity in patients whose disease has progressed after two or more lines of prior therapy for advanced SCLC,” said Chung.

Study participants were 131 patients with advanced SCLC and ECOG performance status of 0 or 1 who were previously treated with 2 lines of therapy, were immunotherapy-naïve, and had progression of disease while on standard therapy. KEYNOTE-028 comprised only patients with PD-L1-positive tumours.

The patients received intravenous pembrolizumab at doses of either 10 mg/kg Q2W (KEYNOTE-028; n=24) or 200 mg Q3W (KEYNOTE-158; n=107) for 2 years or until disease progression or intolerable toxicity. The efficacy analysis included 83 participants, 19 and 64 from KEYNOTE-028 and KEYNOTE-158, respectively (median age 62 years, 64 percent male, 36 percent with ≥3 prior lines of therapy).

At a median follow up of 7.7 months, the objective response rate was 19.3 percent, with two patients having a complete response and 14 having a partial response. Of the 16 responders, 14 had PD-L1-positive tumours. [AACR 2019, abstract CT073]

Median duration of response was not reached and ranged from 4.1 to >35.8 months; nine of the responders had treatment responses for 18 months. Median progression-free survival (PFS) and overall survival (OS) were 2 and 7.7 months, respectively. PFS and OS rates were 16.9 and 34.3 percent, respectively, at 12 months and 13.1 and 20.7 percent, respectively, at 24 months.

“Our findings are particularly noteworthy given that data show that historically, patients with SCLC in the third-line treatment setting have limited survival benefit, with a median duration of response of less than two months and median survival of around two to three months,” said Chung. “Our study shows that pembrolizumab monotherapy can provide durable clinical benefit with manageable toxicity in this hard-to-treat patient population,” he added.

The most common treatment-related adverse events (TRAEs) were fatigue (14 percent), followed by pruritus, rash, and arthralgia (11 percent each). Eight percent of patients experienced grade 3 TRAEs and no grade 4 TRAEs occurred. The grade 5 TRAEs experienced by three patients were intestinal ischaemia, pneumonia, and encephalopathy. Immune-mediated AEs or infusion reactions occurred in 21 percent of the cohort, though none were grade 5 reactions. The most common immune-mediated AE was hypothyroidism (10 percent). Seventy-three patients discontinued study treatment, primarily due to disease progression (n=57).

“Overall, the AEs noted were consistent with the safety profile of pembrolizumab and no new safety signals were identified,” said Chung.

Chung acknowledged that as the method of PD-L1-positivity assessment varied in the two studies, “the role of PD-L1 in patient selection” was not addressed. The retrospective and single-arm design of the trials were also limitations.

“[Nonetheless], this pooled analysis supports the use of pembrolizumab monotherapy for patients with extensive-stage SCLC as third-line or later therapy,” Chung concluded.

 

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Most Read Articles
Christina Lau, 20 Apr 2020

Hippocampal avoidance during whole-brain radiotherapy (HA-WBRT), together with memantine, better preserves cognitive function vs WBRT plus memantine in patients with brain metastases, without compromising survival, a multi-institutional phase III trial has shown.

Natalia Reoutova, 20 May 2020

Cancer patients infected with coronavirus disease 2019 (COVID-19) appear to be at higher risk of severe outcomes, including death, but cancer type and treatment serve as better predictors, according to recent research presented at the American Association for Cancer Research (AACR) 2020 Virtual Annual Meeting I.

At the time of writing, COVID-19 has spread to more than 200 countries and territories, affecting an estimated 4.5 million people and killing over 300,000. Cancer, on the other hand, is newly diagnosed in 18 million people and takes the lives of 10 million every year.

“We have invited physician scientists who are at the epicentre of the COVID-19 pandemic, taking care of patients with cancer. They gathered prospective information to understand the effects of COVID-19 on patients with cancer, are testing new treatments, and are making this knowledge available to the global research community, so we can all benefit from their experience,” said Professor Antoni Ribas from UCLA Medical Center, Los Angeles, California, US, chairperson of the COVID-19 and cancer plenary session of the meeting.

4 days ago
Case presentation: The patient is a 46-year-old Korean lady who first presented with aggravating pleuritic chest pain characterised by a stabbing pain in the chest when inhaling and exhaling. A diagnosis of non-small cell lung cancer (NSCLC) was made from computed tomography (CT)-guided needle aspiration biopsy, and the tumour was found to be epidermal growth factor receptor (EGFR) mutation-positive (exon 19 deletion). Chest imaging revealed the presence of left-sided pleural seeding nodules. The patient was treated with afatanib with partial response as best response. Ten months after starting treatment, the patient experienced disease progression.