# KEYNOTE-483 (CCTG IND.227): pembrolizumab plus chemotherapy versus chemotherapy in untreated pleural mesothelioma

Source: https://onco.cc/key-papers/paper-keynote-483-lancet-2023/  
OnCo record `paper-keynote-483-lancet-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding pembrolizumab to platinum-pemetrexed chemotherapy lengthened survival in untreated pleural mesothelioma by about a year in non-epithelioid tumours and by a smaller margin overall, giving a chemo-immunotherapy option alongside nivolumab-ipilimumab.

## Summary

Phase 3 open-label trial of 440 patients with unresectable advanced pleural mesothelioma in Canada, Italy and France randomised to pembrolizumab plus platinum-pemetrexed or chemotherapy alone.

Median overall survival was 17.3 versus 16.1 months (hazard ratio 0.79), with three-year survival 25 versus 17 percent and a larger effect in non-epithelioid disease; grade 3 to 4 adverse events were more frequent with pembrolizumab.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet
- Year: 2023
- DOI: 10.1016/S0140-6736(23)01613-6
- Authors: Chu Q, Perrone F, Greillier L, et al.
- Findings: Median overall survival 17.3 vs 16.1 months; hazard ratio 0.79.; Three-year overall survival 25 percent vs 17 percent.
- What it means: Pembrolizumab with chemotherapy is approved and offered first line, particularly in epithelioid disease where dual immunotherapy showed little benefit over chemotherapy.
- Caveats: Modest median gain; benefit concentrated in a minority of long-term responders.; Open-label with academic sponsorship and relatively small size.

## Sources

- Lancet 2023: https://doi.org/10.1016/S0140-6736(23)01613-6
- PubMed: https://pubmed.ncbi.nlm.nih.gov/37931632/

## Connected records

- cancers: [Pleural mesothelioma](https://onco.cc/cancers/pleural-mesothelioma/)
- drugs: [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- trials: [IND.227 / KEYNOTE-483](https://onco.cc/trials/keynote-483/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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