“Brief Report: Canadian Cancer Trials Group IND.227”: Unpacking the Clinical Potential of Single-Agent Pembrolizumab in Advanced Malignant Pleural Mesothelioma

Abstract

I read with great interest the recent article by Piccirillo et al. 1 Piccirillo M.C. Chu Q. Bradbury P. et al. Brief report: Canadian cancer trials group IND.227: a phase II randomized study of pembrolizumab in patients with advanced malignant pleural mesothelioma (NCT02784171). J Thor Oncol. 2023; 18: 813-819 Abstract Full Text Full Text PDF Google Scholar on the phase 2 randomized study of pembrolizumab in patients with advanced malignant pleural mesothelioma (IND.227) (NCT02784171). The authors reported a low response rate with single-agent pembrolizumab (13%, 95% confidence interval [CI]: 4%–25%) on the basis of the modified Response Evaluation Criteria in Solid Tumors criteria. As a result, this treatment arm was prematurely closed and the study was amended. 1 Piccirillo M.C. Chu Q. Bradbury P. et al. Brief report: Canadian cancer trials group IND.227: a phase II randomized study of pembrolizumab in patients with advanced malignant pleural mesothelioma (NCT02784171). J Thor Oncol. 2023; 18: 813-819 Abstract Full Text Full Text PDF Google Scholar Brief Report: Canadian Cancer Trials Group IND.227: A Phase 2 Randomized Study of Pembrolizumab in Patients With Advanced Malignant Pleural Mesothelioma (NCT02784171)Journal of Thoracic OncologyVol. 18Issue 6PreviewImmune checkpoint inhibitors have activity in mesothelioma. IND.227 was a phase 2 trial (120 patients planned) comparing progression-free survival of standard platinum and pemetrexed (CP) versus CP + pembrolizumab (pembro) versus pembro. Accrual to the pembro arm was discontinued on the basis of interim analysis (IA—16 wk disease control rate). CP + pembro was tolerable, with progression-free survival similar between arms and median survival and overall response rate higher than those of CP alone (19.8 mo [95% confidence interval or CI: 8.4–41.36] versus 8.9 mo [95% CI: 5.3–12.8] and 47% [95% CI: 24%–71%] versus 19% [95% CI: 5%–42%], respectively). Full-Text PDF Response to a Letter Received Entitled: “‘Brief Report: Canadian Cancer Trials Group IND.227’: Unpacking the Clinical Potential of Single-Agent Pembrolizumab in Advanced Malignant Pleural Mesothelioma”Journal of Thoracic OncologyVol. 18Issue 6PreviewWe like to thank Dr. Gemelli for her comments on our study “Brief report: Canadian Cancer Trials Group IND.227: a phase II randomized study of pembrolizumab in patients with advanced malignant pleural mesothelioma (NCT02784171).” As summarized by Dr. Gemelli, the results of prospective clinical trials for single-agent immune checkpoint inhibitor (ICI) in pleural mesothelioma have been inconsistent. This may be related to the heterogeneous nature of mesothelioma, and as yet unidentified biological differences, which may predict for benefit for ICI. Full-Text PDF