Improved outcome with pembrolizumab added to chemotherapy in mesothelioma

New data recently published on The Lancet showed that pembrolizumab plus platinum-pemetrexed chemotherapy may be a new treatment option for patients with advanced mesothelioma: the combination improved response rates, progression-free survival and overall survival.
The study is a multicenter, open-label phase 3 trial conducted in 51 hospitals in Canada, Italy and France; 440 patients with previously untreated advanced pleural mesothelioma were randomly assigned to chemotherapy alone (cisplatin or carboplatin with pemetrexed) or chemotherapy with pembrolizumab (200 mg every 3 weeks for up to 2 years). At a median follow-up of 16.2 months, the median overall survival was 17.3 months with pembrolizumab plus chemotherapy and 16.1 months with chemotherapy alone; 3 year overall survival rate was 25% with pembrolizumab and 17% with chemotherapy alone. The 1-year progression-free survival rate was 26% with pembrolizumab arm and 17% without it, the 2-year progression-free survival rate was 9% and 4%, respectively; the objective response rate was 62% in the pembrolizumab arm and 38% in the chemotherapy-alone arm. Adverse events occurred in 98% of patients in the pembrolizumab arm and 95% of those in the chemotherapy-alone arm. As authors wrote, «The addition of pembrolizumab to platinum-pemetrexed was a tolerable regimen that resulted in improved overall survival, progression-free survival, and objective response rates compared with platinum-pemetrexed alone, regardless of PD-L1 expression. This regimen, already familiar to thoracic medical oncologists for the treatment of non-small cell lung cancer, represents a new treatment option for patients with advanced pleural mesothelioma, especially for patients at risk of adverse outcomes due to early or rapid progression».