Melanoma: KEYNOTE-054 trial

Abbreviations

2014-004944-37

  • KEYNOTE-054 references
    2018-05-10
    Alexander M.M. Eggermont
    Adjuvant Pembrolizumab versus Placebo in Resected Stage III Melanoma
Investigated (inv)
Comparator (comp)

PEMB

PLB

514

505

Phase:

3

Randomisation:

Double blind

Primary tumour:

Melanoma

Subtype (biomarker):

Any

Stage:

early

Line of therapy:

ADJ

Primary
PEMB
PLB
HR
p
RFS @1yr
75.4%
61.0%
0.57 (0.43-0.74)
<0.001
Secondaries
PEMB
PLB
HR
p
RFS (PD-L1dc-plus) @1yr
77.1%
62.6%
0.54 (0.42-0.69)
<0.001
RFS (PD-L1-) @1yr
72.2%
52.2%
0.47 (0.26-0.85)
0.01
(all grades, %)
PEMB
PLB
p
Fatigue or asthenia
37.1
33.3
NA
Skin reactions
28.3
18.3
NA
Diarrhea
19.1
16.7
NA
Nausea
11.4
8.6
NA
Hypothyroidism
14.3
2.8
NA
Hyperthyroidism
10.2
1.2
NA
Hypophysitisdc-comma including hypopituitarism
2.2
0.2
NA
Respiratorydc-comma thoracic and mediastinal disorders
4.7
0.6
NA
Vitiligo or severe skin reactions
5.3
1.6
NA
Colitis
3.7
0.6
NA
Pancreatitis
0.4
0.2
NA
Hepatitis
1.8
0.2
NA
Nephritis
0.4
0.2
NA
Myocarditis
0.2
0.0
NA
  • Inclusion
  • Exclusion

- Completely resected Stage III melanoma - Tumor tissue available for evaluation of PD-L1 expression - Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 - Adequate organ function - No prior therapy for melanoma except surgery for primary melanoma lesions (or previously treated with interferon for thick primary melanomas without evidence of lymph node involvement are eligible) - Female participants of childbearing potential should be willing to use adequate methods of birth control or be surgically sterile or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication - Male participants should agree to use an adequate method of birth control starting with the first dose of study therapy through 120 days after the last dose of study medication.

- Mucosal or ocular melanoma - History of (non-infectious) pneumonitis that required steroids or current pneumonitis - History of or current interstitial lung disease - History of hematologic or primary solid tumor malignancy, unless no evidence of that disease for 5 years - Active autoimmune disease that has required systemic treatment in past 2 years - Active infection requiring therapy - Unstable hyperthyroidism or hypothyroidism - Diagnosis of immunodeficiency - Systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study medication - Known history of human immunodeficiency virus (HIV), active Hepatitis B or C - Treatment with live vaccine within 30 days prior to the first dose of study medication are not eligible - Prior treatment with any anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4) monoclonal antibody or anti-programmed cell death receptor 1 (PD-1), anti-programmed cell death receptor ligand 1 (PD-L1), or anti-programmed cell death receptor ligand 2 (PD-L2) agent, or prior participation in any Merck pembrolizumab clinical trial - Currently participating and receiving study therapy, or participated in a study of an investigational agent and received study therapy or used an investigation device within 4 weeks of the first dose of study medication - Pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of study medication - Participant is or has an immediate family member (e.g., spouse, parent/legal guardian, sibling or child) who is investigational site or Sponsor staff directly involved with this trial without prospective Institutional Review Board approval (by chair or designee) is given.

Characteristics
PEMB
PLB
Agedc-comma sex - no.(%)
Median age (range)dc-comma yr
54 (19–88)
54 (19–83)
50-65 yr
196 (38.1)
193 (38.2)
≥65 yr
125 (24.3)
126 (25.0)
Male
324 (63.0)
304 (60.2)
Body-mass index — no./total no.(%)
<25
155/501 (30.9)
184/501 (36.7)
25-30
224/501 (44.7)
194/501 (38.7)
≥30
122/501 (24.4)
123/501 (24.6)
Disease stage — no.(%)
IIIA
80 (15.6)
80 (15.8)
IIIB
237 (46.1)
230 (45.5)
IIIC with 1–3 positive lymph nodes
95 (18.5)
93 (18.4)
IIIC with ≥4 positive lymph nodes
102 (19.8)
102 (20.2)
Disease stage (AJCC 2009) — no.(%)
IIIA
77 (15.0)
76 (15.0)
IIIB
240 (46.7)
232 (45.9)
IIIC with 1–3 positive lymph nodes
87 (16.9)
95 (18.8)
IIIC with ≥4 positive lymph nodes
110 (21.4)
102 (20.2)
Type of lymph node involvement — no.(%)
Microscopic
187 (36.4)
161 (31.9)
Macroscopic
327 (63.6)
344 (68.1)
No of positive lymph nodes on pathological testing — no.(%)
1
227 (44.2)
237 (46.9)
2 or 3
177 (34.4)
166 (32.9)
≥4
110 (21.4)
102 (20.2)
Ulceration — no.(%)
Yes
208 (40.5)
197 (39.0)
No
230 (44.7)
251 (49.7)
Unknown
76 (14.8)
57 (11.3)
PD-L1 expression status — no.(%)
Positive
428 (83.3)
425 (84.2)
Negative
59 (11.5)
57 (11.3)
Indeterminate
27 (5.3)
23 (4.6)
BRAF mutation status — no.(%)
Wild type
233 (45.3)
214 (42.4)
V600E or V600K mutation
210 (40.9)
231 (45.7)
Other mutation
35 (6.8)
31 (6.1)
Unknown
36 (7.0)
29 (5.7)
Ad-hoc:
no.pts inv.
no.pts comp.
PEMB
PLB
HR
p
RFS V600K/E MT
210
231
0.54 (0.36-0.83)
0.0001
  • RFS @1yr
analisys of RFS @1yr
PEMB
PLB
HR (95% CI)
Tumor PD-L1 expression
Positive
0.54 (0.39–0.74)
Negative
0.60 (0.28–1.28)
Age
18-65 yr
0.57 (0.41–0.80)
≥65 yr
0.55 (0.32–0.93)
AJCC 2009 melanoma classification
IIIB
0.58 (0.38–0.88)
IIIC
0.58 (0.38–0.86)
No. of positive lymph nodes
2 or 3
0.52 (0.32–0.85)
≥4
0.62 (0.37–1.03)
Lymph-node and ulceration status
Microscopicdc-comma ulceration (n=94)
0.58 (0.29–1.15)
Microscopicdc-comma no ulceration (n=89)
0.48 (0.17–1.30)
Lymph-node and ulceration status
Macroscopicdc-comma ulceration (n=114)
0.51 (0.31–0.86)
Macroscopicdc-comma no ulceration (n=141)
0.79 (0.50–1.26)
BRAF mutation status
Wild type
0.61 (0.41–0.92)
V600E mutation
0.59 (0.38–0.92)
Sex
Male
0.53 (0.37–0.76)
Female
0.62 (0.39–1.00)
Body mass index
25-30
0.63 (0.37-1.10)
≥30
0.47 (0.25-0.91)
Breslow (mm)
≤2
0.64 (0.38-1.09)
>4
0.41 (0.25-0.68)
analisys of
PEMB
PLB
HR (95% CI)