4.8 Article

Pembrolizumab in soft-tissue sarcomas with tertiary lymphoid structures: a phase 2 PEMBROSARC trial cohort

Journal

NATURE MEDICINE
Volume 28, Issue 6, Pages 1199-+

Publisher

NATURE PORTFOLIO
DOI: 10.1038/s41591-022-01821-3

Keywords

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Funding

  1. Institut Bergonie (Bordeaux, France)
  2. MSD
  3. Association pour la Recherche contre le Cancer
  4. Ligue contre le Cancer
  5. INSERM
  6. French National Cancer Institute
  7. Agence Nationale de la Recherche (RHU CONDOR)
  8. Sorbonne Universite
  9. Universite de Paris

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Immune checkpoint inhibitors have limited clinical activity in patients with advanced soft-tissue sarcomas. The presence of TLSs may serve as a potential predictive biomarker for the effectiveness of pembrolizumab treatment in these patients.
Immune checkpoint inhibitors (ICIs) show limited clinical activity in patients with advanced soft-tissue sarcomas (STSs). Retrospective analysis suggests that intratumoral tertiary lymphoid structures (TLSs) are associated with improved outcome in these patients. PEMBROSARC is a multicohort phase 2 study of pembrolizumab combined with low-dose cyclophosphamide in patients with advanced STS (NCT02406781). The primary endpoint was the 6-month non-progression rate (NPR). Secondary endpoints included objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and safety. The 6-month NPR and ORRs for cohorts in this trial enrolling all comers were previously reported; here, we report the results of a cohort enrolling patients selected based on the presence of TLSs (n = 30). The 6-month NPR was 40% (95% confidence interval (CI), 22.7-59.4), so the primary endpoint was met. The ORR was 30% (95% CI, 14.7-49.4). In comparison, the 6-month NPR and ORR were 4.9% (95% CI, 0.6-16.5) and 2.4% (95% CI, 0.1-12.9), respectively, in the all-comer cohorts. The most frequent toxicities were grade 1 or 2 fatigue, nausea, dysthyroidism, diarrhea and anemia. Exploratory analyses revealed that the abundance of intratumoral plasma cells (PCs) was significantly associated with improved outcome. These results suggest that TLS presence in advanced STS is a potential predictive biomarker to improve patients' selection for pembrolizumab treatment.

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