Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/33979
Title: Safety and efficacy of pembrolizumab monotherapy in elderly patients with PD-L1 positive advanced non small-cell lung cancer: Pooled analysis from the KEYNOTE-010, KEYNOTE-024, and KEYNOTE-042 studies
Authors: NOSAKI, KanameSAKA, HideoHOSOMI, YukioBAAS, PaulCASTRO JR., Gilberto deRECK, MartinWU, Yi-LongBRAHMER, Julie R.FELIP, EnriquetaSAWADA, TakeshiNOGUCHI, KazuoHAN, Shi RongPIPERDI, BilalKUSH, Debra A.LOPES, Gilberto
Citation: LUNG CANCER, v.135, p.188-195, 2019
Abstract: Objectives: Most lung cancer diagnoses occur in elderly patients, who are underrepresented in clinical trials. We present a pooled analysis of safety and efficacy in elderly patients (>= 75 years) who received pembrolizumab (a programmed death 1 inhibitor) for advanced non-small-cell lung cancer (NSCLC) with programmed death ligand 1 (PD-L1)-positive tumors. Methods: The pooled analysis included patients aged >= 18 years with advanced NSCLC with PD-L1-positive tumors from the KEYNOTE-010 (NCT01905657), KEYNOTE-024 (NCT02142738), and KEYNOTE-042 (NCT02220894) studies. In KEYNOTE-010, patients were randomized to pembrolizumab 2 or 10 mg/kg every 3 weeks (Q3W) or docetaxel, as second- or later-line therapy. In KEYNOTE-024 and KEYNOTE-042, patients were randomized to first-line pembrolizumab 200 mg Q3W or platinum-based chemotherapy. Overall survival (OS) was estimated by the Kaplan-Meier method, and safety data were summarized in elderly patients (>= 75 years). Results: The analysis included 264 elderly patients with PD-L1-positive tumors (PD-L1 tumor proportion score [TPS] >= 1%); among these, 132 had PD-L1 TPS >= 50%. Pembrolizumab improved OS among elderly patients with PD-L1 TPS >= 1% (hazard ratio [HR], 0.76 [95% CI, 0.56-1.02]) and PD-L1 TPS >= 50% (HR, 0.40 [95% CI, 0.25-0.64]). Pembrolizumab as first-line therapy also improved OS among elderly patients with PD-L1 TPS >= 50% (from KEYNOTE-024 and KEYNOTE-042) compared with chemotherapy (HR, 0.41 [95% CI, 0.23-0.73]). Pembrolizumab was associated with fewer treatment-related adverse events (AEs) in elderly patients (overall, 68.5% vs 94.3%; grade 3, 24.2% vs 61.0%) versus chemotherapy. Immune-mediated AEs and infusion reactions were more common with pembrolizumab versus chemotherapy (overall, 24.8% vs 6.7%; grade 3-4: 9.4% vs 0%; no grade 5 events). Conclusions: In this pooled analysis of elderly patients with advanced NSCLC with PD-L1-positive tumors, pembrolizumab improved OS versus chemotherapy, with a more favorable safety profile. Outcomes with pembrolizumab in patients >= 75 years were comparable to those in the overall populations in the individual studies.
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