Pembrolizumab in patients with rare and ultra-rare sarcomas (AcSé Pembrolizumab): analysis of a subgroup from a non-randomised, open-label, phase 2, basket trial

• Published in: The lancet oncology 2023-08, Vol.24 (8), p.892-902
• Main Authors: Blay, Jean-Yves, Prof, Chevret, Sylvie, Prof, Le Cesne, Axel, Prof, Brahmi, Mehdi, MD, Penel, Nicolas, Prof, Cousin, Sophie, MD, Bertucci, Francois, Prof, Bompas, Emmanuelle, MD, Ryckewaert, Thomas, MD, Soibinet, Pauline, MD, Boudou-Rouquette, Pascaline, MD, Saada Bouzid, Esma, MD, Soulie, Patrick, MD, Valentin, Thibaud, MD, Lotz, Jean-Pierre, Prof, Tosi, Diego, MD, Neviere, Zoé, MD, Cancel, Mathilde, MD, Ray-Coquard, Isabelle, Prof, Gambotti, Laetitia, MD, Legrand, Frédéric, PhD, Lamrani-Ghaouti, Assia, PhD, Simon, Clotilde, PhD, Even, Caroline, MD, Massard, Christophe, Prof
• Format: Article
• Language: English
• Subjects: Adolescent; Adverse events; Alanine transaminase; Alveoli; Antibodies, Monoclonal, Humanized - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Aspartate aminotransferase; Cancer; Clinical trials; Dendritic cells; DNA Helicases; Dyspnea; Female; Hematology, Oncology, and Palliative Medicine; Humans; Immune checkpoint; Immunotherapy; Life Sciences; Male; Metastasis; Middle Aged; Monoclonal antibodies; Nuclear Proteins; Patients; PD-1 protein; PD-L1 protein; Pembrolizumab; Population studies; Radiation therapy; Respiration; Response Evaluation Criteria in Solid Tumors; Response rates; Sarcoma; Sarcoma, Alveolar Soft Part - drug therapy; Soft Tissue Neoplasms - drug therapy; Soft Tissue Neoplasms - pathology; Solid tumors; Targeted cancer therapy; Therapeutic targets; Toxicity; Transcription Factors; Translation; Treatment resistance; Tumors
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(23)00282-6

SummaryBackgroundSarcoma is a heterogeneous group of diseases with few treatment options. Immunotherapy has shown little activity in studies including unselected sarcomas, but immune checkpoint blockers have shown activity in specific histotypes. We evaluated the activity of pembrolizumab in rare and ultra-rare sarcomas. MethodsAcSé Pembrolizumab is an ongoing phase 2, basket, multitumour study investigating the activity of pembrolizumab monotherapy in rare cancers. Here, we report the results obtained in patients with selected histotypes of rare sarcomas (incidence of less than one case per 1 000 000 people per year) recruited at 24 French hospitals. Key inclusion criteria were age 15 years or older, Eastern Cooperative Oncology Group performance status of 0–1, and advanced disease that was untreated and resistant to treatment. Patients were given pembrolizumab 200 mg intravenously on day 1 of every 21-day cycle for a maximum of 24 months. The primary endpoint was objective response rate at week 12 using Response Evaluation Criteria in Solid Tumours version 1.1, assessed by local investigators. The primary endpoint and safety were analysed in the intention-to-treat population. The AcSé Pembrolizumab study is registered with ClinicalTrials.gov, NCT03012620. FindingsBetween Sept 4, 2017, and Dec 29, 2020, 98 patients were enrolled, of whom 97 received treatment and were included in analyses (median age 51 years [IQR 35–65]; 53 [55%] were male; 44 [45%] were female; no data were collected on race or ethnicity). 34 (35%) patients had chordomas, 14 (14%) had alveolar soft part sarcomas, 12 (12%) had SMARCA4-deficient sarcomas or malignant rhabdoid tumours, eight (8%) had desmoplastic small round cell tumours, six (6%) had epithelioid sarcomas, four (4%) had dendritic cell sarcomas, three (3%) each had clear cell sarcomas, solitary fibrous tumours, and myxoid liposarcomas, and ten (10%) had other ultra-rare histotypes. As of data cutoff (April 11, 2022), median follow-up was 13·1 months (range 0·1–52·8; IQR 4·3–19·7). At week 12, objective response rate was 6·2% (95% CI 2·3–13·0), with no complete responses and six partial responses in the 97 patients. The most common grade 3–4 adverse events were anaemia (eight [8%] of 97), alanine aminotransferase and aspartate aminotransferase increase (six [6%]), and dyspnoea (five [5%]). 86 serious adverse events were reported in 37 patients. Five deaths due to adverse events were reported, none of which were determined to