Pembrolizumab + standard chemotherapy beneficial in mesothelioma

The addition of pembrolizumab to standard platinum-pemetrexed chemotherapy results in significant improvement in overall survival among patients with advanced pleural mesothelioma, according to a study published online Nov. 3 in The Lancet.

Quincy Chu, M.D., from the Cross Cancer Institute in Edmonton, Alberta, Canada, and colleagues conducted an open-label, randomized trial at 51 hospitals involving adults with previously untreated advanced pleural mesothelioma. Patients were randomly assigned to receive intravenous chemotherapy (cisplatin or carboplatin with pemetrexed) with or without intravenous pembrolizumab (222 and 218 patients, respectively).

The researchers found that overall survival was significantly longer with pembrolizumab than chemotherapy alone (median overall survival, 17.3 versus 16.1 months; hazard ratio for death, 0.79). The three-year overall survival rate was 25 and 17 percent with pembrolizumab and chemotherapy alone, respectively.

Study treatment-related grade 3 or 4 adverse events occurred in 27 percent of patients in the pembrolizumab group and 15 percent in the chemotherapy group; hospital admissions for study drug-related serious adverse events were reported in 18 and 6 percent of patients, respectively. Two patients in the pembrolizumab group and one in the chemotherapy group reported grade 5 adverse events related to one or more drugs.

"The addition of pembrolizumab to platinum-pemetrexed was a tolerable regimen that did not lead to a detriment in quality of life despite increased toxicity and that resulted in improved overall survival, progression-free survival, and objective response rates compared with platinum and pemetrexed chemotherapy," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Merck, which manufactures pembrolizumab and partially funded the study.

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