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Chan ATC, Lee VHF, Hong RL, Ahn MJ, Chong WQ, Kim SB, Ho GF, Caguioa PB, Ngamphaiboon N, Ho C, Aziz MASA, Ng QS, Yen CJ, Soparattanapaisarn N, Ngan RKC, Kho SK, Tiambeng MLA, Yun T, Sriuranpong V, Algazi AP, Cheng A, Massarelli E, Swaby RF, Saraf S, Yuan J, Siu LL. Pembrolizumab monotherapy versus chemotherapy in platinum-pretreated, recurrent or metastatic nasopharyngeal cancer (KEYNOTE-122): an open-label, randomized, phase III trial. Ann Oncol 2023; 34:251-261. [PMID: 36535566 DOI: 10.1016/j.annonc.2022.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pembrolizumab previously demonstrated robust antitumor activity and manageable safety in a phase Ib study of patients with heavily pretreated, programmed death ligand 1 (PD-L1)-positive, recurrent or metastatic nasopharyngeal carcinoma (NPC). The phase III KEYNOTE-122 study was conducted to further evaluate pembrolizumab versus chemotherapy in patients with platinum-pretreated, recurrent and/or metastatic NPC. Final analysis results are presented. PATIENTS AND METHODS KEYNOTE-122 was an open-label, randomized study conducted at 29 sites, globally. Participants with platinum-pretreated recurrent and/or metastatic NPC were randomly assigned (1 : 1) to pembrolizumab or chemotherapy with capecitabine, gemcitabine, or docetaxel. Randomization was stratified by liver metastasis (present versus absent). The primary endpoint was overall survival (OS), analyzed in the intention-to-treat population using the stratified log-rank test (superiority threshold, one-sided P = 0.0187). Safety was assessed in the as-treated population. RESULTS Between 5 May 2016 and 28 May 2018, 233 participants were randomly assigned to treatment (pembrolizumab, n = 117; chemotherapy, n = 116); Most participants (86.7%) received study treatment in the second-line or later setting. Median time from randomization to data cut-off (30 November 2020) was 45.1 months (interquartile range, 39.0-48.8 months). Median OS was 17.2 months [95% confidence interval (CI) 11.7-22.9 months] with pembrolizumab and 15.3 months (95% CI 10.9-18.1 months) with chemotherapy [hazard ratio, 0.90 (95% CI 0.67-1.19; P = 0.2262)]. Grade 3-5 treatment-related adverse events occurred in 12 of 116 participants (10.3%) with pembrolizumab and 49 of 112 participants (43.8%) with chemotherapy. Three treatment-related deaths occurred: 1 participant (0.9%) with pembrolizumab (pneumonitis) and 2 (1.8%) with chemotherapy (pneumonia, intracranial hemorrhage). CONCLUSION Pembrolizumab did not significantly improve OS compared with chemotherapy in participants with platinum-pretreated recurrent and/or metastatic NPC but did have manageable safety and a lower incidence of treatment-related adverse events.
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Affiliation(s)
- A T C Chan
- State Key Laboratory in Translational Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China.
| | - V H F Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - R-L Hong
- National Taiwan University Hospital, Taipei, Taiwan
| | - M-J Ahn
- Samsung Medical Centre, Seoul, South Korea
| | - W Q Chong
- National University Cancer Institute, Singapore, Singapore
| | - S-B Kim
- Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - G F Ho
- Clinical Oncology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - P B Caguioa
- St. Luke's Medical Center, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - N Ngamphaiboon
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - C Ho
- BC Cancer, University of British Columbia, Vancouver, Canada
| | - M A S A Aziz
- Gleneagles Penang Clinical Research Center, Gleneagles Hospital Penang, Penang, Malaysia
| | - Q S Ng
- National Cancer Centre Singapore, Singapore, Singapore
| | - C-J Yen
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - R K-C Ngan
- Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - S K Kho
- Hospital Umum Sarawak, Kuching, Malaysia
| | - M L A Tiambeng
- Cardinal Santos Medical Center, San Juan City, Philippines
| | - T Yun
- National Cancer Center, Goyang-si, South Korea
| | - V Sriuranpong
- Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - A Cheng
- Princess Margaret Hospital, Hong Kong, China
| | - E Massarelli
- City of Hope Comprehensive Cancer Center, Duarte, USA
| | | | - S Saraf
- Merck & Co., Inc., Rahway, USA
| | - J Yuan
- Merck & Co., Inc., Rahway, USA
| | - L L Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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