Dr. Burtness on the Benefit of Pembrolizumab in Head and Neck Cancer

Barbara Burtness, MD, professor of medicine, Yale Cancer Center, discusses the benefit of pembrolizumab (Keytruda) as a treatment for patients with recurrent metastatic head and neck squamous cell carcinoma.

In the phase III KEYNOTE-048 trial, frontline pembrolizumab was tested as a single-agent and in combination with chemotherapy versus 6 cycles of a platinum agent with 5-FU and cetuximab (Erbitux) followed by cetuximab alone—–known as the EXTREME regimen. When investigators looked at the overall survival (OS) benefit with pembrolizumab and chemotherapy compared with the EXTREME regimen in the biomarker-unselected population, they found a benefit for the early use of pembrolizumab.

OS was improved by about 2 months in the pembrolizumab arm compared with in the EXTREME arm. Response rates were comparable, and the amount of grade 3 to 5 and overall toxicity was fairly similar, Burtness says. This demonstrates that early use of pembrolizumab in patients with recurrent metastatic cancer leads to an improvement in OS, adds Burtness. Findings from the study demonstrated that patients who express PD-L1 do better with pembrolizumab monotherapy and those who are not biomarker-enriched do better with the combination of pembrolizumab and chemotherapy.