Despite showing promise in phase 2 trials, new results from a randomized phase 3 [ immunotherapy in mesothelioma ] trial are disappointing in a tumor type that remains a major killer.
In patients with malignant pleural mesothelioma (MPM) who had progressed after first-line chemotherapy, immunotherapy with pembrolizumab (Keytruda, Merck) appears to offer no survival advantages over standard chemotherapy.
The results come from the PROMISE-meso study, presented here at the European Society of Medical Oncology (ESMO) annual meeting.
Despite “nearly four times more patients” responding to immunotherapy than standard chemotherapy, “unfortunately these responses did not delay progression or improve survival,” noted study investigator Sanjay Popat, MD, PhD, thoracic medical oncologist, Royal Marsden Hospital NHS Foundation Trust, London, England.
However, while pembrolizumab “was not superior to chemotherapy, survival was similar, and so pembrolizumab may represent an alternative.”
He highlighted that, as in other immunotherapy trials in other cancer types, some of the mesothelioma patients had long responses, which suggests that some patients could “preferentially receive this treatment over chemotherapy.”
Popat also suggested that, learning a lesson from lung cancer trials, combining immunotherapy with chemotherapy could have a beneficial effect.
“I would advise clinicians to enroll their patients into one of the large ongoing trials of first-line combination treatment so we can get answers as soon as possible about how to improve mesothelioma treatment,” he said.
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