KEYNOTE-590 Trial Impacting Treatment Landscape for ESCC and Upper GI Cancer

EP: 1.Prevalence and Characteristics of GI Cancers

EP: 2.Evolving Treatment Landscape for Upper GI and Esophageal Cancer

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EP: 3.KEYNOTE-590 Trial Impacting Treatment Landscape for ESCC and Upper GI Cancer

EP: 4.Overview of CheckMate Trials 648 and 649

EP: 5.Aligning ESCC and GI Cancer Treatment Strategies With Current Guidelines

EP: 6.Quality of Life Impacted by Treatment of ESCC and Upper GI Cancer

EP: 7.Optimizing Treatment Pathways for Patients with ESCC and GI Cancer

EP: 8.The Evolving Treatment Landscape of Upper GI and Esophageal Cancer

EP: 9.Key Cost Drivers in Treating Gastroesophageal Cancers

EP: 10.Unmet Needs for Patients With Esophageal and Upper-GI Cancers

EP: 11.Role of Immune Checkpoint Inhibitors in Gastroesophageal Cancer Treatment Landscape

EP: 12.Decision-Making Within a Rapidly Evolving Field Where Labeling May Differ From Current Clinical Guidelines

EP: 13.Determining Individual Treatment Sequencing for Patients with Gastroesophageal Cancer

EP: 14.Selecting Optimal Gastroesophageal Treatment: Chemotherapy, Immunotherapy, and Combined Therapies

EP: 15.New Gastroesophageal Treatment Therapies Impacting Patient Quality of Life

EP: 16.Defining Appropriate Response to Gastroesophageal Cancer Treatment

EP: 17.Immunotherapy Considerations for Upper GI and Esophageal Cancer Treatment Pathways

EP: 18.Evaluating Gastroesophageal Cancer Pathway Decisions

EP: 19.Cost-Effective Analyses for Upper GI and Esophageal Cancer Treatment

EP: 20.Patient-Support Services and Programs for Patients With Gastroesophageal Cancer

Syma Iqbal, MD: KEYNOTE-590 was a randomized phase 3 trial for patients with untreated esophageal cancer, both adenocarcinoma and squamous cell carcinoma. This was a global study. Patients were randomized to chemotherapy vs chemotherapy plus pembrolizumab. The coprimary end points of the study were overall survival and progression-free survival in all comers and patients who had a PD-L1 CPS [combined positive score] of 10 or greater. The majority of patients who participated in the trial had squamous cell carcinoma. That was approximately 70% of the population. About 50% of the patients were accrued from Asia.

This trial demonstrated that patients who received chemotherapy, 5-FU [5-fluorouracil] and platinum-based treatment plus pembrolizumab, had a superior outcome in terms of overall survival compared with chemotherapy alone. This was demonstrated in all comers and patients with a PD-L1 CPS of 10 or greater. Furthermore, this was demonstrated significantly in patients who had esophageal squamous cell carcinoma. Based on this study, the FDA approved the addition of pembrolizumab to chemotherapy for patients with adenocarcinoma and squamous cell carcinoma in combination with 5-FU–platinum–based treatment. As such, it has been incorporated into care for this population.

This study demonstrated an improvement in overall survival from 8 to 9 months to about 13 months. There was statistically significant improvement in outcome in the CPS 10 and greater population as well as all comers.

Transcript edited for clarity.