Previously reported data for pembrolizumab were from a heterogeneous, non-randomised cohort in which 31% of patients were treatment naive, 64% were ipilimumab naive, 36% received previous ipilimumab (confi rmed progression not required), and BRAF or MEK inhibitor, or both, treatment was not required for BRAF-mutant melanoma. By comparison, the current randomised cohort enrolled was a more
homogeneous and heavily pretreated population because all patients had disease that progressed on previous ipilimumab (confi rmed with two tumour assessments), 72% received at least two previous systemic therapies, and treatment with a BRAF or MEK inhibitor, or both, was required for all patients with BRAF-mutant melanoma. These factors might explain the lower percentages of patients with complete response (1% vs 9%), any response (26% vs 41%), 24-week PFS (37% and 45% vs 54%), and overall survival
at 1 year (58% and 63% vs 81%) in the present cohort. It is important to note that the pattern and duration of response are consistent with those reported previously. The complete response rate and ORR with pembrolizumab are also generally consistent with those reported for nivolumab in patients with melanoma previously treated with at least three
previous doses of ipilimumab (20% ORR, 3% complete response rate [as per modifi ed WHO criteria]).
The safety data corroborate previously published data showing that anti-PD-1 therapy is generally well tolerated and safe in patients previously treated with ipilimumab, with a safety profile similar to that reported for ipilimumab-naive patients. Most drug-related adverse events in the current study were of grade 1 or 2 severity and were reversible. Although uncommon, severe adverse events of potential immune cause were successfully managed with treatment interruption or immunosuppressive therapy, or both. The overall safety profile was similar in the 2 mg/kg and the 10 mg/kg groups, and no deaths due to drug-related adverse events were reported.
Previously reported data for pembrolizumab were from a heterogeneous, non-randomised cohort in which 31% of patients were treatment naive, 64% were ipilimumab naive, 36% received previous ipilimumab (confi rmed progression not required), and BRAF or MEK inhibitor, or both, treatment was not required for BRAF-mutant melanoma. By comparison, the current randomised cohort enrolled was a morehomogeneous and heavily pretreated population because all patients had disease that progressed on previous ipilimumab (confi rmed with two tumour assessments), 72% received at least two previous systemic therapies, and treatment with a BRAF or MEK inhibitor, or both, was required for all patients with BRAF-mutant melanoma. These factors might explain the lower percentages of patients with complete response (1% vs 9%), any response (26% vs 41%), 24-week PFS (37% and 45% vs 54%), and overall survivalat 1 year (58% and 63% vs 81%) in the present cohort. It is important to note that the pattern and duration of response are consistent with those reported previously. The complete response rate and ORR with pembrolizumab are also generally consistent with those reported for nivolumab in patients with melanoma previously treated with at least threeprevious doses of ipilimumab (20% ORR, 3% complete response rate [as per modifi ed WHO criteria]).The safety data corroborate previously published data showing that anti-PD-1 therapy is generally well tolerated and safe in patients previously treated with ipilimumab, with a safety profile similar to that reported for ipilimumab-naive patients. Most drug-related adverse events in the current study were of grade 1 or 2 severity and were reversible. Although uncommon, severe adverse events of potential immune cause were successfully managed with treatment interruption or immunosuppressive therapy, or both. The overall safety profile was similar in the 2 mg/kg and the 10 mg/kg groups, and no deaths due to drug-related adverse events were reported.
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