1
|
Najjar YG, McCurry D, Lin H, Lin Y, Zang Y, Davar D, Karunamurthy A, Drabick JJ, Neves RI, Butterfield LH, Ernstoff MS, Puzanov I, Skitzki JJ, Bordeaux J, Summit IB, Bender JO, Kim JY, Chen B, Sarikonda G, Pahuja A, Tsau J, Alfonso Z, Laing C, Pingpank JF, Holtzman MP, Sander C, Rose A, Zarour HM, Kirkwood JM, Tarhini AA. Neoadjuvant Pembrolizumab and High-Dose IFNα-2b in Resectable Regionally Advanced Melanoma. Clin Cancer Res 2021; 27:4195-4204. [PMID: 33753453 PMCID: PMC8338751 DOI: 10.1158/1078-0432.ccr-20-4301] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/13/2020] [Accepted: 03/16/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Neoadjuvant immunotherapy may improve the clinical outcome of regionally advanced operable melanoma and allows for rapid clinical and pathologic assessment of response. We examined neoadjuvant pembrolizumab and high-dose IFNα-2b (HDI) therapy in patients with resectable advanced melanoma. PATIENTS AND METHODS Patients with resectable stage III/IV melanoma were treated with concurrent pembrolizumab 200 mg i.v. every 3 weeks and HDI 20 MU/m2/day i.v., 5 days per week for 4 weeks, then 10 MU/m2/day subcutaneously 3 days per week for 2 weeks. Definitive surgery followed, as did adjuvant combination immunotherapy, completing a year of treatment. Primary endpoint was safety of the combination. Secondary endpoints included overall response rate (ORR), pathologic complete response (pCR), recurrence-free survival (RFS), and overall survival (OS). Blood samples for correlative studies were collected throughout. Tumor tissue was assessed by IHC and flow cytometry at baseline and at surgery. RESULTS A total of 31 patients were enrolled, and 30 were evaluable. At data cutoff (October 2, 2019), median follow-up for OS was 37.87 months (range, 33.2-43.47). Median OS and RFS were not reached. Radiographic ORR was 73.3% [95% confidence interval (CI): 55.5-85.8], with a 43% (95% CI: 27.3-60.1) pCR rate. None of the patients with a pCR have had a recurrence. HDI and pembrolizumab were discontinued in 73% and 43% of patients, respectively. Correlative analyses suggested that intratumoral PD-1/PD-L1 interaction and HLA-DR expression are associated with pCR (P = 0.002 and P = 0.008, respectively). CONCLUSIONS Neoadjuvant concurrent HDI and pembrolizumab demonstrated promising clinical activity despite high rates of treatment discontinuation. pCR is a prognostic indicator.See related commentary by Menzies et al., p. 4133.
Collapse
Affiliation(s)
- Yana G Najjar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania.
| | | | - Huang Lin
- Biostatistics Facility, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Yan Lin
- Biostatistics Facility, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Yan Zang
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Diwakar Davar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Arivarasan Karunamurthy
- Division of Molecular and Genomic Pathology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | | | - Lisa H Butterfield
- Parker Institute for Cancer Immunotherapy, and Department of Microbiology and Immunology, University of California San Francisco, San Francisco, California
| | | | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Jennifer Bordeaux
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | - IlaSri B Summit
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | - Jehovana O Bender
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | - Ju Young Kim
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | - Beiru Chen
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | | | - Anil Pahuja
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | - Jennifer Tsau
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | - Zeni Alfonso
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | - Christian Laing
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, California
| | | | | | - Cindy Sander
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Amy Rose
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | | | - Ahmad A Tarhini
- H. Lee Moffit Cancer Center and Research Institute, Tampa, Florida.
| |
Collapse
|