On October 10, 2023 Merck (NYSE: MRK), known as MSD outside of the United States and Canada, reported the Phase 3 KEYNOTE-671 trial investigating KEYTRUDA, Merck’s anti-PD-1 therapy, as a perioperative treatment regimen for patients with resectable stage II, IIIA or IIIB (T3-4N2) non-small cell lung cancer (NSCLC) met its dual primary endpoint of overall survival (OS) (Press release, Merck & Co, OCT 10, 2023, View Source [SID1234635810]). At a pre-specified interim analysis, KEYTRUDA plus chemotherapy before surgery (neoadjuvant), followed by resection and KEYTRUDA as a single agent after surgery (adjuvant), demonstrated a statistically significant and clinically meaningful improvement in OS compared to neoadjuvant placebo plus chemotherapy followed by adjuvant placebo in these patients.
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The safety profile of KEYTRUDA was consistent with that observed in previously reported studies; no new safety signals were identified. Full results from this analysis of KEYNOTE-671 will be presented at the European Society for Medical Oncology (ESMO) (Free ESMO Whitepaper) Congress 2023 and shared with regulatory authorities worldwide.
"This is a significant milestone in the treatment of resectable non-small cell lung cancer, as it represents the first Phase 3 study to show a statistically significant overall survival benefit for these patients with stage II, IIIA or IIIB (T3-4N2) non-small cell lung cancer. These results build upon the previously reported event-free survival data, and demonstrate the potential for this KEYTRUDA-based regimen to help extend the lives of these patients," said Dr. Marjorie Green, senior vice president and head of late-stage oncology, global clinical development, Merck Research Laboratories. "We’re excited by the progress we have made to help patients with earlier stages of non-small cell lung cancer, who are in need of additional treatment options."
As previously announced, at the first interim analysis, KEYNOTE-671 met the other one of its dual primary endpoints, event-free survival (EFS), as well as its key secondary endpoints of pathological complete response (pCR) and major pathological response (mPR). These results were presented at the 2023 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) and, based on these data, the U.S. Food and Drug Administration (FDA) has accepted Merck’s new supplemental Biologics License Application (sBLA) with a Prescription Drug User Fee Act (PDUFA), or target action, date of October 16, 2023.
Merck has an extensive clinical development program in lung cancer and is advancing multiple registration-enabling studies, with research directed at earlier stages of disease and novel combinations. Key studies in earlier stages of NSCLC and small cell lung cancer (SCLC) include KEYNOTE-671, KEYNOTE-091, KEYNOTE-867, KEYLYNK-012, KEYVIBE-006 and KEYLYNK-013.
About KEYNOTE-671
KEYNOTE-671 is a randomized, double-blind Phase 3 trial (ClinicalTrials.gov, NCT03425643) evaluating neoadjuvant KEYTRUDA plus chemotherapy, followed by adjuvant KEYTRUDA as a single agent versus placebo plus neoadjuvant chemotherapy, followed by adjuvant placebo in patients with resectable stage II, IIIA or IIIB (T3-4N2) NSCLC. The trial’s dual primary endpoints are EFS and OS. Key secondary endpoints include pCR and mPR. The study enrolled 786 patients who were randomly assigned (1:1) to receive either:
KEYTRUDA (200 mg intravenously [IV] every three weeks [Q3W] for up to four cycles) plus chemotherapy (cisplatin [75 mg/m^2, IV; given on Day 1 of each cycle] and either gemcitabine [1000 mg/m^2, IV; given on Days 1 and 8 of each cycle) or pemetrexed [500 mg/m^2, IV; given on Day 1 of each cycle]) as neoadjuvant therapy prior to surgery, followed by KEYTRUDA (200 mg IV Q3W for up to 13 cycles) as adjuvant therapy post-surgery, or
Placebo (saline IV Q3W for up to four cycles) plus chemotherapy (cisplatin [75 mg/m^2, IV; given on Day 1 of each cycle] and either gemcitabine [1000 mg/m^2, IV; given on Days 1 and 8 of each cycle] or pemetrexed [500 mg/m^2, IV; given on Day 1 of each cycle]) as neoadjuvant therapy prior to surgery, followed by placebo (saline IV Q3W for up to 13 cycles) as adjuvant therapy post-surgery.
About lung cancer
Lung cancer is the leading cause of cancer death worldwide. In 2020 alone, there were more than 2.2 million new cases and 1.8 million deaths from lung cancer globally. Non-small cell lung cancer is the most common type of lung cancer, accounting for about 81% of all cases. In the U.S., the overall five-year survival rate for patients diagnosed with lung cancer is 25%, which is a 21% improvement over the last five years. Improved survival rates are due, in part, to earlier detection and screening, advances in diagnostic and surgical procedures, as well as the introduction of new therapies. Early detection and screening remain an important unmet need, as 44% of lung cancer cases are not found until they are advanced. Only 5.8% of people in the U.S. who are eligible were screened for lung cancer in 2021.