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Hamid O, Robert C, Daud A, Hodi FS, Hwu WJ, Kefford R, Wolchok JD, Hersey P, Joseph R, Weber JS, Dronca R, Mitchell TC, Patnaik A, Zarour HM, Joshua AM, Zhao Q, Jensen E, Ahsan S, Ibrahim N, Ribas A. Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001. Ann Oncol 2019; 30:582-588. [PMID: 30715153 PMCID: PMC6503622 DOI: 10.1093/annonc/mdz011] [Citation(s) in RCA: 567] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pembrolizumab demonstrated robust antitumor activity and safety in the phase Ib KEYNOTE-001 study (NCT01295827) of advanced melanoma. Five-year outcomes in all patients and treatment-naive patients are reported herein. Patients whose disease progressed following initial response and who received a second course of pembrolizumab were also analyzed. PATIENTS AND METHODS Patients aged ≥18 years with previously treated or treatment-naive advanced/metastatic melanoma received pembrolizumab 2 mg/kg every 3 weeks, 10 mg/kg every 3 weeks, or 10 mg/kg every 2 weeks until disease progression, intolerable toxicity, or patient/investigator decision to withdraw. Kaplan-Meier estimates of overall survival (OS) and progression-free survival (PFS) were calculated. Objective response rate and PFS were based on immune-related response criteria by investigator assessment (data cut-off, September 1, 2017). RESULTS KEYNOTE-001 enrolled 655 patients with melanoma; median follow-up was 55 months. Estimated 5-year OS was 34% in all patients and 41% in treatment-naive patients; median OS was 23.8 months (95% CI, 20.2-30.4) and 38.6 months (95% CI, 27.2-not reached), respectively. Estimated 5-year PFS rates were 21% in all patients and 29% in treatment-naive patients; median PFS was 8.3 months (95% CI, 5.8-11.1) and 16.9 months (95% CI, 9.3-35.5), respectively. Median response duration was not reached; 73% of all responses and 82% of treatment-naive responses were ongoing at data cut-off; the longest response was ongoing at 66 months. Four patients [all with prior response of complete response (CR)] whose disease progressed during observation subsequently received second-course pembrolizumab. One patient each achieved CR and partial response (after data cut-off). Treatment-related AEs (TRAEs) occurred in 86% of patients and resulted in study discontinuation in 7.8%; 17% experienced grade 3/4 TRAE. CONCLUSIONS This 5-year analysis of KEYNOTE-001 represents the longest follow-up for pembrolizumab to date and confirms the durable antitumor activity and tolerability of pembrolizumab in advanced melanoma. CLINICAL TRIAL REGISTRY ClinicalTrials.gov, NCT01295827.
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Affiliation(s)
- O Hamid
- Medical Oncology, The Angeles Clinic and Research Institute, Los Angeles, USA.
| | - C Robert
- Department of Dermatology, Gustave Roussy, Villejuif; Department of Medicine, University of Paris-Sud, Paris, France
| | - A Daud
- Department of Medicine, University of California, San Francisco, San Francisco
| | - F S Hodi
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - W J Hwu
- Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Kefford
- Medical Oncology, Westmead Hospital, Westmead; Medical Oncology, Melanoma Institute Australia, Sydney; Medical Oncology, Macquarie University, Macquarie Park; Medical Oncology, University of Sydney, Sydney, Australia
| | - J D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - P Hersey
- Medical Oncology, University of Sydney, Sydney, Australia; Department of Medicine, Centenary Institute, Sydney, Australia
| | - R Joseph
- Medical Oncology, Mayo Clinic Cancer Center-Florida, Jacksonville
| | - J S Weber
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York
| | - R Dronca
- Medical Oncology, Mayo Clinic Cancer Center-Florida, Jacksonville
| | - T C Mitchell
- Division of Hematology Oncology, Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - A Patnaik
- Medical Oncology, South Texas Accelerated Research Therapeutics, San Antonio
| | - H M Zarour
- Department of Immunology, University of Pittsburgh Cancer Institute, Pittsburgh, USA
| | - A M Joshua
- Medical Oncology, Melanoma Institute Australia, Sydney; Medical Oncology, University of Sydney, Sydney, Australia; Kinghorn Cancer Centre, St. Vincent's Hospital, Medical Oncology, Garvan Institute of Medical Research, Sydney; Medical Oncology, University of New South Wales, Sydney, Australia
| | - Q Zhao
- Merck & Co., Inc., Kenilworth
| | | | - S Ahsan
- Merck & Co., Inc., Kenilworth
| | | | - A Ribas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
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Fourcade JJ, Kudela P, Andrade Filho PA, Janjic BM, Land SR, Sander C, Krieg AM, Donnenberg AD, Shen H, Kirkwood JM, Zarour HM. Phase I study of immunization with the analogue peptide NY-ESO-1 157–165V in combination with CpG (PF-3512676) and Montanide ISA 720 in patients with stage III/IV melanoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zarour HM, Land S, Sander C, Mascari R, Storkus WJ, Shipe-Spotloe J, Stover L, Herberman RB, Agarwala SS, Kirkwood JM. Phase I-II vaccine trial with MHC class II and MHC class I epitopes from Melan-A/MART-1 for patients with metastatic melanoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- H. M. Zarour
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - S. Land
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - C. Sander
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - R. Mascari
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - W. J. Storkus
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - L. Stover
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - S. S. Agarwala
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - J. M. Kirkwood
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Zarour HM, Storkus WJ, Brusic V, Williams E, Kirkwood JM. NY-ESO-1 encodes DRB1*0401-restricted epitopes recognized by melanoma-reactive CD4+ T cells. Cancer Res 2000; 60:4946-52. [PMID: 10987311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The NY-ESO-1 gene is expressed by a range of human tumors and encodes HLA-A2-restricted melanoma peptides recognized by CD8+ CTLs. Here we report that the NY-ESO-1 gene also encodes two overlapping, but non-cross-reactive, HLA-DRB1*0401-presented peptides that are recognized by CD4+ T cells. The NY-ESO-1(119-143) peptide was able to induce specific CD4+ T cells in vitro from both an HLA-DRB1*0401+ normal donor and an HLA-DRB1*0401+ patient with melanoma. Bulk and cloned CD4+ T cells produced IFN-gamma specifically in response to, and also lysed, T2.DR4 cells pulsed with peptide NY-ESO-1(119-143) and the autologous tumor cell line, but not a DRB1*0401+ melanoma cell line that does not express NY-ESO-1. Interestingly, the NY-ESO119-143 peptide contains two overlapping putative "core" epitopes recognized by non-cross-reactive anti-NY-ESO-1(119-143) CD4+ T-cell clones. Taken together, these data support the use of this novel DR4-restricted tumor peptide, NY-ESO-1(119-143), or its two "sub-epitopes" in immunotherapeutic trials designed to generate or enhance specific CD4+ T-cell responses against tumors expressing NY-ESO-1 in vivo.
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Affiliation(s)
- H M Zarour
- Department of Medicine and Melanoma Center, University of Pittsburgh Cancer Institute, Pennsylvania 15213, USA.
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Storkus WJ, Zarour HM. Melanoma antigens recognised by CD8+ and CD4+ T cells. Forum (Genova) 2000; 10:256-70. [PMID: 11007933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The field of melanoma immunobiology has made tremendous strides in the past decade, resulting in the molecular identification of a vast array of tumour-expressed antigens that contain determinants that are recognised by patient T cells or immunoglobulins. The integration of these antigens, their derivative peptides or improved analogues in vaccine trials allows for the augmentation of melanoma-specific CD4+ and CD8+ T cells in situ that may prove clinically efficacious in the adjuvant or therapeutic setting. Indeed, melanoma peptide-based immunotherapies targeting the activation of anti-tumour CD8+ cytotoxic T lymphocytes have proven successful (i.e. yielding objective clinical responses), particularly when combined with T cell growth factors or potent antigen-presenting cells, such as dendritic cells. Vaccine approaches implementing poly-epitope and/or melanoma peptides recognised by CD4+ T cells are anticipated to yield still better clinical outcomes due to the in vivo promotion and maintenance of a diversified, poly-specific effector T cell repertoire directed against resident tumours.
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Affiliation(s)
- W J Storkus
- Departments of Surgery and Molecular Genetics and Biochemistry at the University of Pittsburgh School of Medicine and Melanoma Center, University of Pittsburgh Cancer Institute, Pennsylvania, USA
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Zarour HM, Kirkwood JM, Kierstead LS, Herr W, Brusic V, Slingluff CL, Sidney J, Sette A, Storkus WJ. Melan-A/MART-1(51-73) represents an immunogenic HLA-DR4-restricted epitope recognized by melanoma-reactive CD4(+) T cells. Proc Natl Acad Sci U S A 2000; 97:400-5. [PMID: 10618430 PMCID: PMC26675 DOI: 10.1073/pnas.97.1.400] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The human Melan-A/MART-1 gene encodes an HLA-A2-restricted peptide epitope recognized by melanoma-reactive CD8(+) cytotoxic T lymphocytes. Here we report that this gene also encodes at least one HLA-DR4-presented peptide recognized by CD4(+) T cells. The Melan-A/MART-1(51-73) peptide was able to induce the in vitro expansion of specific CD4(+) T cells derived from normal DR4(+) donors or from DR4(+) patients with melanoma when pulsed onto autologous dendritic cells. CD4(+) responder T cells specifically produced IFN-gamma in response to, and also lysed, T2.DR4 cells pulsed with the Melan-A/MART-1(51-73) peptide and DR4(+) melanoma target cells naturally expressing the Melan-A/MART-1 gene product. Interestingly, CD4(+) T cell immunoreactivity against the Melan-A/MART-1(51-73) peptide typically coexisted with a high frequency of anti-Melan-A/MART-1(27-35) reactive CD8(+) T cells in freshly isolated blood harvested from HLA-A2(+)/DR4(+) patients with melanoma. Taken together, these data support the use of this Melan-A/MART-1 DR4-restricted melanoma epitope in future immunotherapeutic trials designed to generate, augment, and quantitate specific CD4(+) T cell responses against melanoma in vivo.
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Affiliation(s)
- H M Zarour
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA.
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