Second-Line Pembrolizumab vs. Chemotherapy for Advanced Esophageal Cancer

Based on a trial of patients with refractory esophagogastric adenocarcinoma, pembrolizumab was approved in the U.S. for late-line treatment of PD-L1–positive or MSI-high cancers. However, a recent trial of pembrolizumab versus paclitaxel in the second-line treatment of PD-L1–positive gastric and GE junction adenocarcinoma was negative (NEJM JW Oncol Hematol Sep 2018 and Lancet 2018; 392:123).

Researchers now report results of KEYNOTE-181, an industry-sponsored, international, open-label, randomized, phase III trial of second-line treatment with pembrolizumab versus investigators' choice of chemotherapy (paclitaxel, docetaxel, or irinotecan) for 628 patients with esophageal and GE junction adenocarcinoma or squamous cell cancer. Most patients…