KEYNOTE-590: pembrolizumab plus chemotherapy for first-line treatment of advanced oesophageal cancer
Adding pembrolizumab to cisplatin-fluorouracil lengthened survival in advanced oesophageal cancer of both histologies, most clearly in squamous cell carcinoma and in tumours with high PD-L1, establishing chemo-immunotherapy as the first-line standard.
Overview
Phase 3 placebo-controlled trial of 749 patients with untreated advanced oesophageal or Siewert type 1 junctional cancer (73 percent squamous) randomised to pembrolizumab or placebo with cisplatin and fluorouracil.
Median overall survival was 12.4 versus 9.8 months overall (hazard ratio 0.73), 13.9 versus 8.8 months in squamous cell carcinoma with combined positive score of 10 or more (hazard ratio 0.57), and progression-free survival was improved in all groups.
- Median overall survival 12.4 vs 9.8 months overall; hazard ratio 0.73.
- Squamous with combined positive score 10 or more: 13.9 vs 8.8 months; hazard ratio 0.57.
Pembrolizumab plus chemotherapy is a first-line standard for advanced oesophageal cancer, with the strongest recommendation for PD-L1-expressing tumours.
- Benefit in adenocarcinoma and in low PD-L1 tumours was smaller.
- Cisplatin-fluorouracil backbone is less used in some regions.
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