Pembrolizumab as first-line treatment for metastatic uveal melanoma

• DOI: 10.1007/s00262-019-02352-6
• Publication Date: 2019-06-07T13:02:40Z
• Authors: Ernesto Rossi; Monica Maria Pagl...; Daniela Orteschi; Tommaso Dosa; Maria Grazia Samm...; Carmela Grazia Ca...; Gianluigi Petrone; Guido Rindi; Marcella Zollino; Maria Antonietta ...; Alessandra Cassano; Emilio Bria; Giampaolo Tortora; Giovanni Schinzari
• Keywords: Adult; Aged, 80 and over; Male; Uveal Neoplasms; 0301 basic medicine; Programmed Cell Death 1 Receptor; Middle Aged; Antibodies, Monoclonal, Humanized; Progression-Free Survival; 3. Good health; 03 medical and health sciences; Antineoplastic Agents, Immunological; First line; Immunotherapy; Liver metastases; Pembrolizumab; Uveal melanoma; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Female; Humans; Male; Melanoma; Middle Aged; Programmed Cell Death 1 Receptor; Progression-Free Survival; Prospective Studies; Uveal Neoplasms; Humans; Original Article; Female; Prospective Studies; Melanoma; Aged

No standard treatment has been defined for metastatic uveal melanoma (mUM). Although clinical trials testing Nivolumab/Pembrolizumab for cutaneous melanoma did not include mUM, anti PD-1 agents are commonly used for this disease.In this prospective observational cohort single arm study, we investigated efficacy and safety of Pembrolizumab as first-line therapy for mUM. The efficacy was evaluated in terms of progression-free survival (PFS), response rate and overall survival (OS). Toxicity was also assessed.Seventeen patients were enrolled. A median of 8 cycles were administered (range 2-28). Two patients achieved partial response (11.7%), 6 a disease stabilization (35.3%), whereas 9 (53%) had a progression. No complete response was observed. PFS of the overall population was 3.8 months. PFS was 9.7 months for patients with an interval higher than 5 years from diagnosis of primary tumor to metastatic disease and 2.6 months for patients with an interval lower than 5 years [p = 0.039, HR 0.2865 (95% CI 0.0869-0.9443)]. Median OS was not reached. The two responding patients were still on treatment with Pembrolizumab at the time of data analysis. Survival was 12.8 months for patients with clinical benefit, while OS for progressive patients was 3.1 months. PD-L1 expression and genomic abnormalities predictive of relapse after diagnosis of primary tumor were not associated with PFS. Toxicity was mild, without grade 3-4 side effects.The efficacy of Pembrolizumab does not seem particularly different when compared to other agents for mUM, but responding patients had a remarkable disease control.