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KEYNOTE-170 showed that a PD-1 antibody works in primary mediastinal B-cell lymphoma, whose cells carry extra copies of the PD-L1 gene: almost half of heavily treated patients responded, which led to the first drug approval specific to this lymphoma.
KEYNOTE-170 treated 53 patients with relapsed or refractory primary mediastinal large B-cell lymphoma with pembrolizumab 200 mg every three weeks for up to two years. The disease is defined by gains and rearrangements of the 9p24.1 locus that carries PD-L1, PD-L2 and JAK2, the same lesion that makes classical Hodgkin lymphoma so sensitive to PD-1 blockade.
The objective response rate was 45 percent with 13 percent complete responses, and responses were durable, with the median duration not reached at a median follow-up of over a year. Together with the KEYNOTE-013 cohort this supported FDA accelerated approval in June 2018 for patients who had relapsed after two or more lines, the first approval of any drug specifically for this lymphoma.
CheckMate 436 later combined nivolumab with brentuximab vedotin in the same setting with a higher response rate, and CD19 CAR-T products licensed for large B-cell lymphoma include primary mediastinal disease in their labels.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
53 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Objective response rateprimary | Pembrolizumab | 53 | 45% | - | - | link |
| Complete response rate | Pembrolizumab | 53 | 13% | - | - | link |
Shares KEYNOTE-170: pembrolizumab in relapsed or refractory primary mediastinal large B-cell lymphoma, Primary mediastinal (thymic) large B-cell lymphoma.
Shares PD-L1, PD-1, Immune checkpoint inhibitors.
Shares PD-L1, Merck & Co. (MSD), PD-1, Pembrolizumab.
Shares PD-L1, PD-1, Pembrolizumab, Immune checkpoint inhibitors.
Shares PD-L1, PD-1, Immune checkpoint inhibitors.
Shares PD-L1, PD-1, Pembrolizumab, Immune checkpoint inhibitors.
Shares PD-L1, PD-1, Immune checkpoint inhibitors.
Shares PD-L1, Merck & Co. (MSD), PD-1, Pembrolizumab.