Armand Philippe, Shipp Margaret A, Ribrag Vincent, Michot Jean-Marie, Zinzani Pier Luigi, Kuruvilla John, Snyder Ellen S, Ricart Alejandro D, Balakumaran Arun, Rose Shelonitda, Moskowitz Craig H
Philippe Armand and Margaret A. Shipp, Dana-Farber Cancer Institute, Boston, MA; Vincent Ribrag and Jean-Marie Michot, Institut Gustave Roussy, Villejuif, France; Pier Luigi Zinzani, Institute of Hematology Seràgnoli, University of Bologna, Bologna, Italy; John Kuruvilla, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Ellen S. Snyder, Alejandro D. Ricart, Arun Balakumaran, and Shelonitda Rose, Merck, Kenilworth, NJ; and Craig H. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY.
J Clin Oncol. 2016 Nov 1;34(31):3733-3739. doi: 10.1200/JCO.2016.67.3467.
Purpose Classical Hodgkin lymphoma (HL) frequently exhibits genetic alterations leading to overexpression of the programmed death-1 (PD-1) ligands, suggesting a possible vulnerability to PD-1 blockade. The phase Ib study KEYNOTE-013 (NCT01953692) tested the safety and efficacy of the anti-PD-1 antibody pembrolizumab in patients with hematologic malignancies. Based on its genetics, HL was included as an independent cohort. Methods We enrolled patients with relapsed or refractory HL whose disease progressed on or after treatment with brentuximab vedotin. Patients received pembrolizumab, 10 mg/kg every 2 weeks, until disease progression occurred. Response to treatment was assessed at week 12 and every 8 weeks thereafter. Principal end points were safety and complete remission (CR) rate. Results Thirty-one patients were enrolled; 55% had more than four lines of prior therapy, and 71% had relapsed after autologous stem cell transplantation. Five patients (16%) experienced grade 3 drug-related adverse events (AEs); there were no grade 4 AEs or deaths related to treatment. The CR rate was 16% (90% CI, 7% to 31%). In addition, 48% of patients achieved a partial remission, for an overall response rate of 65% (90% CI, 48% to 79%). Most of the responses (70%) lasted longer than 24 weeks (range, 0.14+ to 74+ weeks), with a median follow-up of 17 months. The progression-free survival rate was 69% at 24 weeks and 46% at 52 weeks. Biomarker analyses demonstrated a high prevalence of PD-L1 and PD-L2 expression, treatment-induced expansion of T cells and natural killer cells, and activation of interferon-γ, T-cell receptor, and expanded immune-related signaling pathways. Conclusions Pembrolizumab was associated with a favorable safety profile. Pembrolizumab treatment induced favorable responses in a heavily pretreated patient cohort, justifying further studies.
目的 经典型霍奇金淋巴瘤(HL)常表现出导致程序性死亡-1(PD-1)配体过表达的基因改变,提示其可能对PD-1阻断治疗敏感。Ib期研究KEYNOTE-013(NCT01953692)测试了抗PD-1抗体帕博利珠单抗在血液系统恶性肿瘤患者中的安全性和疗效。基于其遗传学特征,HL被纳入一个独立队列。方法 我们纳入了复发或难治性HL患者,这些患者在用维布妥昔单抗治疗时或治疗后疾病进展。患者接受帕博利珠单抗治疗,每2周10mg/kg,直至疾病进展。在第12周及此后每8周评估治疗反应。主要终点是安全性和完全缓解(CR)率。结果 共纳入31例患者;55%的患者接受过4线以上的既往治疗,71%的患者在自体干细胞移植后复发。5例患者(16%)发生3级药物相关不良事件(AE);无4级AE或与治疗相关的死亡。CR率为16%(90%CI,7%至31%)。此外,48%的患者达到部分缓解,总缓解率为65%(90%CI,48%至79%)。大多数缓解(70%)持续超过24周(范围,0.14 +至74 +周),中位随访时间为17个月。24周时无进展生存率为69%,52周时为46%。生物标志物分析显示PD-L1和PD-L2表达普遍存在,治疗诱导T细胞和自然杀伤细胞扩增,以及干扰素-γ、T细胞受体激活和免疫相关信号通路的扩展。结论 帕博利珠单抗具有良好的安全性。帕博利珠单抗治疗在经过大量预处理的患者队列中诱导了良好的反应,值得进一步研究。
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