Fase III que utiliza Nab-Paclitaxel + Carboplatino y Pembrolizumab en NSCLC escamoso. El hazard ratio favorece a Nab paclitaxel en el análisis de subgrupos.
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Cco keynote 407
1. KEYNOTE-407: Phase III Trial of Carboplatin +
Paclitaxel/nab-Paclitaxel ± Pembrolizumab in
Patients With Untreated Stage IV Squamous NSCLC
This activity is supported by educational grants from Amgen; Astellas; AstraZeneca;
Celgene Corporation; Eisai; Genentech; Janssen; Merck & Co., Inc.; and Seattle Genetics.
CCO Independent Conference Highlights*
of the 2018 ASCO Annual Meeting; June 1-5, 2018; Chicago, Illinois
*CCO is an independent medical education company that provides state-of-the-art medical information to
healthcare professionals through conference coverage and other educational programs.
2. Carboplatin + Paclitaxel/nab-Paclitaxel ±
Pembrolizumab in NSCLC (KEYNOTE-407): Background
Pembrolizumab: monoclonal antibody targeting PD-1
‒ Significantly improved OS and PFS with fewer AEs vs platinum-based
chemotherapy in patients with untreated advanced squamous or
nonsquamous PD-L1–positive NSCLC[1]
‒ Significantly improved OS and PFS when added to pemetrexed + a
platinum-based agent in patients with untreated metastatic
nonsquamous NSCLC, regardless of PD-L1 status[2]
Current prespecified second interim analysis evaluates efficacy and
safety of pembrolizumab addition to platinum-based chemotherapy in
patients with untreated metastatic squamous NSCLC[3]
1. Reck M, et al. N Engl J Med. 2016;375:1823-1833. 2. Gandhi L, et al. N Engl J Med.
2018;378:2078-2092. 3. Paz-Ares LG, et al. ASCO 2018. Abstract 105. Slide credit: clinicaloptions.com
3. Randomized, double-blind phase III trial
Primary endpoint: PFS by RECIST v1.1 (BICR), OS
Secondary endpoints: ORR and DoR by RECIST v1.1 (BICR), safety
KEYNOTE-407: Study Design
Paz-Ares LG, et al. ASCO 2018. Abstract 105. ClinicalTrials.gov. NCT02775435. Slide credit: clinicaloptions.com
Pembrolizumab + Carboplatin +
Paclitaxel or nab-Paclitaxel
3-wk cycles x 4
(n = 278)
Patients with untreated stage IV
squamous NSCLC, ECOG PS 0/1,
available tumor biopsy for PD-L1
assessment, no brain mets, and
no pneumonitis requiring
systemic steroids
(N = 559)
Stratified by PD-L1 TPS (< 1% vs ≥ 1%), taxane (paclitaxel
vs nab-paclitaxel), region (east Asia vs other)
Carboplatin AUC 6 Q3W, nab-paclitaxel 100 mg/m2 QW, paclitaxel 200 mg/m2 Q3W, pembrolizumab 200 mg Q3W.
*Upon confirmation of PD and safety criteria by BICR, optional crossover could occur during combination or monotherapy.
Placebo + Carboplatin +
Paclitaxel or nab-Paclitaxel
3-wk cycles x 4
(n = 281)
Pembrolizumab
up to 31 cycles
Placebo
up to 31 cycles
Pembrolizumab
up to 35 cycles
Crossover
allowed*
PD
4. KEYNOTE-407: Baseline Characteristics
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Slide credit: clinicaloptions.com
Characteristic Pembro + Chemo (n = 278) Chemo (n = 281)
Median age, yrs (range) 65 (29-87) 65 (36-88)
Male, n (%) 220 (79.1) 235 (83.6)
ECOG PS 1, n (%) 205 (73.7) 191 (68.0)
Stable brain metastases, n (%) 20 (7.2) 24 (8.5)
Former/current smoker, n (%) 256 (92.1) 262 (93.2)
Enrolled in east Asia, n (%) 54 (19.4) 52 (18.5)
PD-L1 TPS ≥ 1%, n (%) 176 (63.3) 177 (63.0)
Paclitaxel chosen as taxane, n (%) 169 (60.8) 167 (59.4)
Prior thoracic radiation, n (%) 17 (6.1) 22 (7.8)
Prior (neo)adjuvant therapy, n (%) 5 (1.8) 8 (2.8)
5. KEYNOTE-407: PFS by RECIST v1.1 (BICR) in ITT Population
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Reproduced with permission. Slide credit: clinicaloptions.com
Mos
Patients at Risk, n
PFS(%)
Median PFS, Mos (95% CI)
6.4 (6.2-8.3)
4.8 (4.3-5.7)
100
80
60
40
20
0
0 3 6 9 12 15 18 21
Pembro + Chemo
Chemo
54.7
70.1
0.56
(0.45-0.70)
< .0001
Events, % HR (95% CI) P Value
278
281
223
190
142
90
57
26
23
12
5
4
0
0
0
0
6. KEYNOTE-407: OS in ITT Population
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Reproduced with permission. Slide credit: clinicaloptions.com
Mos
Patients at Risk, n
OS(%)
Median OS, Mos (95% CI)
15.9 (13.2-NE)
11.3 (9.5-14.8)
100
80
60
40
20
0
0 3 6 9 12 15 18 21
Pembro + Chemo
Chemo
30.6
42.7
0.64
(0.49-0.85)
0.0008
Events, % HR (95% CI) P Value
278
281
256
246
188
175
124
93
62
45
17
16
2
4
0
0
7. KEYNOTE-407: OS in Key Subgroups
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Reproduced with permission. Slide credit: clinicaloptions.com
Subgroup
Overall
Age
< 65 yrs
≥ 65 yrs
Sex
Male
Female
ECOG PS
0
1
Region of enrollment
East Asia
Rest of world
Choice of taxane
Paclitaxel
Nab-paclitaxel
Deaths/Patients,
n/N
205/559
88/254
117/305
167/455
38/104
48/163
157/396
34/106
171/453
140/336
65/223
0.64 (0.49-0.85)
0.52 (0.34-0.80)
0.74 (0.51-1.07)
0.69 (0.51-0.94)
0.42 (0.22-0.81)
0.54 (0.29-0.98)
0.66 (0.48-0.90)
0.44 (0.22-0.89)
0.69 (0.51-0.93)
0.67 (0.48-0.93)
0.59 (0.36-0.98)
HR (95% CI)
Chemo BetterPembro + Chemo Better
0.1 0.5 1
8. KEYNOTE-407: PFS, OS by PD-L1 TPS
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Slide credit: clinicaloptions.com
Survival by PD-L1 Expression,
Mos (95% CI)
Pembro + Chemo Chemo HR (95% CI)
Median PFS by RECIST v1.1 (BICR)
TPS < 1%
TPS 1% to 49%
TPS ≥ 50%
6.3 (6.1-6.5)
7.2 (6.0-11.4)
8.0 (6.1-10.3)
5.3 (4.4-6.2)
5.2 (4.2-6.2)
4.2 (2.8-4.6)
0.68 (0.47-0.98)
0.56 (0.39-0.80)
0.37 (0.24-0.58)
Median OS
TPS < 1%
TPS 1% to 49%
TPS ≥ 50%
15.9 (13.1-NE)
14.0 (12.8-NE)
NR (11.3-NE)
10.2 (8.6-13.8)
11.6 (8.9-17.2)
NR (7.4-NE)
0.61 (0.38-0.98)
0.57 (0.36-0.90)
0.64 (0.37-1.10)
Pembro + chemo: TPS < 1%, n = 95; TPS 1% to 49%, n = 103; TPS ≥ 50%, n = 73.
Chemo: TPS < 1%, n = 99; TPS 1% to 49%, n = 104; TPS ≥ 50%, n = 73.
9. KEYNOTE-407: Secondary Endpoints
Median follow-up: 7.8 mos (0.1-19.1)
Mean treatment duration
‒ Pembro + chemo: 6.3 mos
‒ Chemo: 4.7 mos
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Slide credit: clinicaloptions.com
Response
Pembro +
Chemo
(n = 278)
Chemo
(n = 281)
ORR, % (95% CI)
57.9
(51.9-63.8)
38.4
(32.7-44.4)
CR, n (%) 4 (1.4) 6 (2.1)
PR, n (%) 157 (56.5) 102 (36.3)
SD, n (%) 78 (28.1) 104 (37.0)
PD, n (%) 17 (6.1) 39 (13.9)
Not evaluable,* n (%) 6 (2.2) 7 (2.5)
Not assessed,† n (%) 16 (5.8) 23 (8.2)
*Patients with ≥ 1 post-BL imaging assessment but none evaluable per
RECIST v1.1 (BICR). †Patients without ≥ 1 post-BL imaging assessment.
Outcome
Pembro +
Chemo
(n = 161)
Chemo
(n = 108)
Median DoR, mos
(range)
7.7
(1.1+ to 14.7+)
4.8
(1.3+ to 15.8+)
10. KEYNOTE-407: Safety
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Slide credit: clinicaloptions.com
Summary of AE, n (%) Pembro + Chemo (n = 278) Chemo (n = 280)
All cause 273 (98.2) 274 (97.9)
Grade 3-5 194 (69.8) 191 (68.2)
Led to death
Treatment related
23 (8.3)
10 (3.6)
18 (6.4)
6 (2.1)
Led to discontinuation
All treatment
Any treatment
37 (13.3)
65 (23.4)
18 (6.4)
33 (11.8)
Immune-mediated and infusion reactions
Grade 3-5
Led to death
80 (28.8)
30 (10.8)
1 (0.4)
24 (8.6)
9 (3.2)
1 (0.4)
12. KEYNOTE-407: Conclusions
In patients with untreated metastatic squamous NSCLC, addition of pembrolizumab to
carboplatin + paclitaxel or nab-paclitaxel significantly improved survival regardless of PD-L1
expression level
‒ Median PFS: 6.4 vs 4.8 mos (P < .0001); median OS: 15.9 vs 11.3 mos (P = .0008)
ORR, DoR also improved with addition of pembrolizumab to chemotherapy in this setting
Safety profile consistent with known data for regimen constituents
‒ D/c rates for AEs low overall but numerically higher in pembrolizumab arm
‒ Immune-mediated AEs also more common in pembrolizumab arm; frequency/severity comparable
to studies with pembrolizumab monotherapy
Study investigators suggest that pembrolizumab + carboplatin + paclitaxel or nab-paclitaxel
should be a standard frontline treatment for metastatic squamous NSCLC with any PD-L1 TPS
Paz-Ares LG, et al. ASCO 2018. Abstract 105. Slide credit: clinicaloptions.com
13. clinicaloptions.com/oncology
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