Pembrolizumab: first anti-PD-1/L1-based regimen for first-line treatment of advanced esophageal cancer in Japan

ABSTRACT

Introduction

Esophageal cancer (EC) is the ninth most common cancer in Japanese men. Esophageal squamous cell carcinoma (ESCC) is the major histological type and accounts for 90% of EC cases in Japan. The prognosis of advanced ESCC remains poor. The standard treatment for advanced ESCC was palliative chemotherapy with 5-fluorouracil plus cisplatin as first-line chemotherapy. After failure of first-line chemotherapy, taxanes were used as second-line chemotherapy. Recently, pembrolizumab monotherapy has demonstrated benefits as a second-line treatment in patients with advanced ESCC and a combined positive score of ≥10. Survival was found to be improved in patients with advanced EC who received first-line treatment with pembrolizumab plus doublet chemotherapy than in those who received doublet chemotherapy alone.

Areas covered

This overview of immune checkpoint inhibitors focuses on pembrolizumab in combination with chemotherapy and shares key clinical data relevant to the treatment of patients with EC in Japan.

Expert opinion

Pembrolizumab plus doublet chemotherapy is now an established first-line treatment for advanced EC in Japan. Recently, nivolumab plus doublet chemotherapy and nivolumab plus ipilimumab have also become first-line treatment options for patients with advanced ESCC. Further investigations are needed to identify biomarkers that would be useful for selecting candidates for these treatments.

KEYWORDS:

• Esophageal cancer
• esophageal squamous cell carcinoma
• immune checkpoint inhibitors
• pembrolizumab

Article highlights

• The prognosis of Japanese patients with advanced esophageal squamous cell carcinoma is still poor, and a few drugs such as platinum and fluoropyrimidine and taxane are effective for these patients.

• Pembrolizumab is a recombinant humanized immunoglobulin monoclonal antibody that targets PD-1.

• Pembrolizumab plus doublet chemotherapy as a first-line treatment showed clinical efficacy for patients with advanced esophageal cancer based on the results of the KEYNOTE-590 trial.

• In Japanese subgroup analysis of the KEYNOTE-590 trial, efficacy and safety of pembrolizumab plus doublet chemotherapy were similar for Japan and globally.

• Clinical trials related to pembrolizumab-containing treatments such as the LEAP-014 trial and KEYMAKER-06 trial are developing.

Drug summary box

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Declaration of interest

K Kato has received research funds from ONO, Bristol Myers Squibb, Merck Sharp & Dohme, Beigeen, Shionogi, and Oncolys Biopharma, and honoraria from ONO, Eli Lilly and Taiho. S Yamamoto has received honoraria from ONO and Bristol Myers Squibb. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Company review

Merck Sharp & Dohme provided a scientific accuracy review at the request of the journal editor.

Additional information

Funding

This paper was not funded.