Pembrolizumab as First-line Therapy in Cisplatin-ineligible Advanced Urothelial Cancer (KEYNOTE-052): Outcomes in Older Patients by Age and Performance Status

被引:41
作者
Grivas, Petros [1 ]
Plimack, Elizabeth R. [2 ]
Balar, Arjun, V [3 ]
Castellano, Daniel [4 ]
O'Donnell, Peter H. [5 ]
Bellmunt, Joaquim [6 ]
Powles, Thomas [7 ]
Hahn, Noah M. [8 ]
de Wit, Ronald [9 ]
Bajorin, Dean F. [10 ]
Ellison, Misoo C. [11 ]
Frenkl, Tara L. [11 ]
Godwin, James L. [11 ]
Vuky, Jacqueline [12 ]
机构
[1] Univ Washington, Fred Hutchinson Canc Res Ctr, Seattle Canc Care Alliance, Seattle, WA 98109 USA
[2] Fox Chase Canc Ctr, 7701 Burholme Ave, Philadelphia, PA 19111 USA
[3] NYU Langone Hlth, Perlmutter Canc Ctr, New York, NY USA
[4] Hosp Univ 12 Octubre, Madrid, Spain
[5] Univ Chicago, Chicago, IL 60637 USA
[6] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Boston, MA 02115 USA
[7] Queen Mary Univ London, Barts Canc Inst, London, England
[8] Johns Hopkins Univ, Sidney Kimmel Comprehens Canc Ctr, Baltimore, MD USA
[9] Erasmus MC Canc Inst, Rotterdam, Netherlands
[10] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA
[11] Merck & Co Inc, Kenilworth, NJ USA
[12] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
来源
EUROPEAN UROLOGY ONCOLOGY | 2020年 / 3卷 / 03期
关键词
Aged; Bladder cancer; Checkpoint inhibitor; Cisplatin ineligible; Immunotherapy; Programmed death 1; Pembrolizumab; Platinum ineligible; Poor performance status; Urothelial carcinoma; GEMCITABINE; UNFIT;
D O I
10.1016/j.euo.2020.02.009
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Patients with treatment-naive advanced urothelial cancer (UC) ineligible for cisplatin-based chemotherapy are typically older and have comorbidities, representing a difficult-to-treat population. Objective: To evaluate the safety and antitumor activity of first-line pembrolizumab in subgroups of cisplatin-ineligible older patients (aged >= 65 and >= 75 yr) with advanced UC in KEYNOTE-052 (NCT02335424), including those with poor performance status (Eastern Cooperative Oncology Group performance status score 2 [ECOG PS2]). Design, setting, and participants: Patients were cisplatin ineligible, had treatmentnaive, histologically/cytologically confirmed, locally advanced/metastatic UC with measurable disease (Response Evaluation Criteria in Solid Tumors version 1.1 [RECIST v1.1]), and had ECOG PS0-2. Patient subgroups analyzed were aged >= 65 yr (n = 302), >= 75 yr (n = 179), >= 65 yr with ECOG PS2 (>= 65 yr + ECOG PS2; n = 119), and >= 75 yr + ECOG PS2 (n = 78). Intervention: All patients received pembrolizumab 200 mg intravenously every 3 wk until confirmed progression, intolerable toxicity, patient withdrawal, or 24 mo of therapy. Outcome measurements and statistical analysis: The primary endpoint was objective response rate (ORR) as per RECIST v1.1. The key secondary endpoints were overall survival (OS), duration of response (DOR), and safety. Results and limitations: ORRs for the >= 65 yr, >= 75 yr, >= 65 yr + ECOG PS2, and >= 75 yr + ECOG PS2 subgroups were 29%, 27%, 29%, and 31%, respectively; rates of complete and partial responses were similar across subgroups (9%, 5%, 6%, and 6%, and 20%, 22%, 23%, and 24%, respectively). Median DOR and OS were also consistent across the >= 65 yr and >= 65 yr + ECOG PS2 subgroups and the >= 75 yr and >= 75 yr + ECOG PS2 subgroups. Study limitations included open-label design, lack of a comparator group, and nature of post hoc exploratory analysis. Conclusions: The clinical benefit of pembrolizumab in advanced UC appeared to be consistent regardless of age and/or poor performance status. Patient summary: This study looked at whether older age and poorer performance status affect how well patients with previously untreated advanced urothelial cancer ineligible for standard-of-care treatment respond to pembrolizumab. Outcomes with pembrolizumab were not affected by older age or poorer performance status, making it an effective option. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.
引用
收藏
页码:351 / 359
页数:9
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