The FDA has approved (pembrolizumab) Keytruda for the treatment of relapsed or refractory primary mediastinal large B-cell lymphoma (PMBCL).
Indications: Keytruda, a programmed death receptor-1 (PD-1)-blocking antibody is indicated for the treatment of adult and pediatric patients with refractory PMBCL or who have relapsed after 2 or more prior lines of therapy. It is not recommended for treatment of patients with PMBCL who require urgent cytoreductive therapy.
Keytruda also is indicated for the treatment of melanoma, non-small cell lung cancer, head and neck squamous cell carcinoma, classical Hodgkin lymphoma, urothelial carcinoma, microsatellite instability-high cancer, gastric cancer, and cervical cancer.
Dosage and administration: For adults, the recommended dose is 200 mg every 3 weeks. In pediatric patients, the recommended dose is 2 mg/kg every 3 weeks, with a maximum dose of 200 mg.
Efficacy and safety: Based on a multicenter, open-label, single-arm trial of 53 patients with relapsed or refractory PMBCL (KEYNOTE-170; NCT02576990), the overall response rate was 45%, with 11% of patients seeing a complete response and 34% seeing a partial response.
Side effects/risks: The most common adverse reactions to pembrolizumab were musculoskeletal pain, upper respiratory tract infection, pyrexia, fatigue, cough, dyspnea, diarrhea, nausea, arrhythmia, and headache. In total, a quarter of patients with adverse reactions required systemic treatment with a corticosteroid and 26% of patients had serious adverse reactions.
This Week's Must Reads
Observational study shows hydroxyurea well tolerated in sickle cell disease, Dauvergne B et al. FSCDR 2018, presentation JSCDH-D-18-00052
CAVEAT shows venetoclax plus chemo appropriate for older, fit AML patients , Wei AH et al. EHA Congress, Abstract S1564.
Large cohort study demonstrates DOAC safety vs. warfarin , Vinogradova Y et al. BMJ 2018;362:k2505.
Patients who develop AML may have detectable mutations years earlier, Desai P et al. Nat Med. 2018;24:1015-23.
Oral administration of arsenic + ATRA effective for APML, Zhu HH et al. Lancet Oncol. 2018;19:871-9.
Must Reads in Aggressive Lymphomas
Escalating venetoclax dose was safe in relapsed CLL, Koenig K et al. EHA Congress (annual meeting of the European Hematology Association), Abstract PF357.
PET findings safely drive chemo decisions in Hodgkin lymphoma patients, Casasnovas O et al. ASCO 2018 (annual meeting of the American Society of Clinical Oncology), Abstract 7503.
Ibrutinib and venetoclax for relapsed CLL, Niemann C et al. European Society of Hematology Annual Congress 2018. Abstract PF346.
Durable responses seen from lisocabtagene in relapsed/refractory DLBCL, Abramson JS et al. ASCO 2018. Abstract 7505
ADC + BR improves response rate in diffuse large B-cell lymphoma, Sehn LH et al. EHA Congress, Abstract S802.