Pembrolizumab near the end of life in patients with metastatic pancreatic cancer: a multi-site consecutive series to examine survival and patient treatment burden.

Abstract

Pembrolizumab confers minimal benefit tomost patients with pancreas cancer. We explored survival and patient treatment burden (for example, death within 14days of therapy) in a subgroup who had early accessto pembrolizumab. This multisite study examined consecutive pancreascancer patients, who received pembrolizumab from 2004 through 2022. Median overall survival of > 4months was to be deemed favorable. Patient treatment burden and medical record quotations are presented descriptively. Forty-one patients (median age 66years; range 36, 84) are included. Fifteen (37%) had dMMR, MSI-H, TMB-H, or Lynch syndrome; and 23 (56%) received concurrent therapy. The median overall survival was 7.2months (95% confidence interval (CI): 5.2, 12.7months); 29 were deceasedat the time of reporting. Patients with dMMR, MSI-H, TMB-H, or Lynch syndrome had a lower risk of death: hazard ratio (HR): 0.29 (95% CI: 0.12, 0.72); p = 0.008. Medical record phrases ("brilliant response") aligned with the above. One patient died within 14days of therapy, and one was in an intensive care unit within 30days of death. Fifteenpatients enrolled in hospice; four of these died < 3days later. These unexpectedly favorable findings underscore the need for healthcare providers-including palliative care providers-to knowledgeably guide patients about cancer therapy evennear the end of life.