This month, Professor Lang-Lazdunski focusses on the IND227 trial which was presented at the ASCO annual meeting 2023.

In the IND227 trial, more pronounced benefits of the immunotherapy were observed in patients with non-epithelioid histology, but the combination of pembrolizumab and chemotherapy provided only a small survival benefit.
Adding pembrolizumab to standard platinum–pemetrexed chemotherapy shows to be superior to chemotherapy only in terms of overall survival (OS) in previously untreated patients with advanced pleural mesothelioma, as reported in the recently published study IND227 trial (Lancet. 2023 Nov 3:S0140-6736(23)01613-6).
The open-label, international, randomised phase 3 IND227 trial involved 440 patients at 51 hospitals in Canada, Italy, and France, randomly assigning them to chemotherapy alone (n=218) or chemotherapy with pembrolizumab (n=222). All patients had advanced pleural mesothelioma unsuitable for surgery.
At final analysis, with a median follow-up of 16.2 months, median OS with pembrolizumab plus chemotherapy was 17.3 months (95% CI 14·4–21·3) compared to 16.1 months in the group treated with chemotherapy alone (hazard ratio for death 0·79; 95% CI 0·64–0·98). 3-year overall survival rate was 25% (95% CI 20–33%) with the combination therapy and 17% (13–24%) with chemotherapy alone.
"The study showed a small benefit in terms of survival when immunotherapy is added to chemotherapy, more marked in patients with non-epithelioid subtype for whom chemotherapy alone is generally not very effective. Unfortunately, the hazard ratios for overall and progression-free survival did not reach the study preplanned HR of 0.70 for significance.
Although overall survival was significantly longer with the combination therapy compared to chemotherapy alone, median survival improvement was only slightly longer than one month.
Most of the patients in both groups reported at least one adverse event, with grade 3 or 4 related events reported in 27% of patients in the pembrolizumab + chemotherapy group and 15% of patients in the chemotherapy only group. The most frequently occurring adverse events in both groups were fatigue and nausea and 16% of patients discontinued pembrolizumab due to side effects. Overall, the pembrolizumab containing regimen was tolerable, despite an increase of toxic effects and provided a small survival benefit.
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