IAN CHAU, MD, a consultant medical oncologist at the Gastrointestinal and Lymphoma Units of The Royal Marsden NHS Foundation Trust in London and Surrey, United Kingdom, was the invited discussant of KEYNOTE-062.
Ian Chau, MD
In an interview with The ASCO Post, he first commented that although single-agent pembrolizumab is a new option, it would probably not be suitable for the patient who needs a rapid response due to a large tumor burden or symptoms. “Some patients cannot wait for the results of combined positive score (CPS) testing, and pembrolizumab also takes a while to work,” he said. “But there’s a group of patients for whom pembrolizumab works well, and they can have a long duration of response and impressive survival benefit…. Within this group, I really think there is something there,” he commented.
“We have all used single-agent [programmed cell death protein 1/ programmed cell death ligand 1] antibodies, and we know the toxicity profile is favorable. If you take away the financial toxicity—ie, make the drug accessible to the patient—then it’s a valid treatment option, even for patients with a CPS ≥ 1, but especially for patients with a CPS ≥ 10, where the superiority of single-agent pembrolizumab was inferred in KEYNOTE-062,” Dr. Chau said.
He hopes patient selection can be refined, since 1 mg of pembrolizumab is more than the price of 1 mg of gold, he indicated to attendees. He also hopes future trials will evaluate pembrolizumab in combination with other agents (aside from chemotherapy) and that their designs will be less complex than KEYNOTE-062.
“Multiplicity of comparisons, ie, splitting of the alpha,” he suggested, may be one reason why pembrolizumab plus chemotherapy was not better than chemotherapy alone. “Let’s bring simplicity back!” ■
DISCLOSURE: Dr. Chau is a consultant or advisor for AstraZeneca, Bayer, Bristol-Myers Squibb, Lilly, Merck Serono, MSD Oncology, Oncologie International, Pierre Fabre, and Roche/Genentech and has received honoraria from Lilly; travel expenses from Bristol-Myers Squibb, Lilly, Merck Serono, and MSD; and institutional research funding from Janssen-Cilag, Sanofi, Merck Serono, and Lilly.
KEYNOTE-062, a study of first-line treatment in patients with advanced gastric or gastroesophageal junction adenocarcinoma, found pembrolizumab to be noninferior to chemotherapy and perhaps better than chemotherapy in a subgroup of patients. The results were reported at the 2019 ASCO Annual Meeting ...