Merck (MRK) Announces KEYTRUDA Approved in Japan in Combination With Chemotherapy for First-Line Treatment of Patients With Radically Unresectable, Advanced or Recurrent Esophageal Carcinoma
Merck (NYSE: MRK), known as MSD outside the United States and Canada, today announced that KEYTRUDA, Merck’s anti-PD-1 therapy, has been approved by the Japan Pharmaceuticals and Medical Devices Agency (PMDA) for the first-line treatment of patients with radically unresectable, advanced or recurrent esophageal carcinoma in combination with chemotherapy (5-fluorouracil [5-FU] plus cisplatin) based on data from the Phase 3 KEYNOTE-590 trial.
“In Japan, patients living with advanced esophageal cancer face a poor prognosis with current chemotherapy regimens,” said Dr. Scot Ebbinghaus, vice president, clinical research, Merck Research Laboratories. “This approval offers a new treatment option with KEYTRUDA, which has been shown to improve overall survival and progression-free survival when combined with chemotherapy compared to standard of care chemotherapy as a first-line treatment for patients with radically unresectable, advanced or recurrent esophageal carcinoma.”
“The burden of esophageal cancer is high in Japan, where cases are increasing,” said Kyle Tattle, president, MSD Japan. “It is encouraging that now appropriate patients with esophageal cancer have an immunotherapy regimen option with KEYTRUDA earlier in the treatment course that can potentially extend their lives. We remain committed to addressing the most challenging cancers affecting Japanese patients and working with the government to provide access to patients in Japan.”
In the KEYNOTE-590 trial, KEYTRUDA in combination with chemotherapy (5-FU plus cisplatin) demonstrated statistically significant improvements in overall survival and progression-free survival versus chemotherapy alone (5-FU plus cisplatin) in chemotherapy-naïve patients with radically unresectable, advanced or recurrent esophageal squamous cell carcinoma or esophageal adenocarcinoma or adenocarcinoma of the esophagogastric junction (Siewert type 1), regardless of histology or PD-L1 expression status. KEYTRUDA plus chemotherapy reduced the risk of death by 27% (HR=0.73 [95% CI, 0.62-0.86]; p<0.0001) and reduced the risk of disease progression or death by 35% (HR=0.65 [95% CI, 0.55-0.76]; p<0.0001) versus chemotherapy alone.
The Japanese package insert notes that in KEYNOTE-590, adverse reactions were observed in 364 patients (98.4%) out of the safety analysis set of 370 patients (including 73 out of 74 Japanese patients) receiving KEYTRUDA at a dose of 200 mg every three weeks in combination with 5-FU and cisplatin. The most commonly observed adverse reactions (≥20%) were nausea in 233 patients (63.0%), decreased appetite in 145 patients (39.2%), anemia in 143 patients (38.6%), fatigue in 135 patients (36.5%), neutrophil count decreased in 135 patients (36.5%), vomiting in 110 patients (29.7%), diarrhea in 97 patients (26.2%), neutropenia and stomatitis in 96 patients (25.9% each) and white blood cell count decreased in 89 patients (24.1%).
This is the second indication for KEYTRUDA in esophageal cancer in Japan and is the 16th indication overall. In 2020, KEYTRUDA was approved in Japan for the second-line treatment of patients with radically unresectable, advanced or recurrent esophageal squamous cell carcinoma whose tumors express PD-L1.
Esophageal cancer begins in the inner layer (mucosa) of the esophagus and grows outward. Esophageal cancer is the eighth most commonly diagnosed cancer and the sixth leading cause of cancer death worldwide. In Japan, esophageal cancer is the tenth most commonly diagnosed cancer and the ninth leading cause of cancer death. It is estimated there were more than 26,000 new cases of esophageal cancer diagnosed and more than 12,000 deaths from the disease in 2020. Merck is studying KEYTRUDA across multiple settings and stages of gastrointestinal cancer through its broad clinical program, including studies in esophageal, gastric, hepatobiliary, pancreatic, colorectal and anal cancers.
About KEYTRUDA® (pembrolizumab) Injection, 100 mg
KEYTRUDA is an anti-programmed death receptor-1 (PD-1) therapy that works by increasing the ability of the body’s immune system to help detect and fight tumor cells. KEYTRUDA is a humanized monoclonal antibody that blocks the interaction between PD-1 and its ligands, PD-L1 and PD-L2, thereby activating T lymphocytes which may affect both tumor cells and healthy cells.
Merck has the industry’s largest immuno-oncology clinical research program. There are currently more than 1,600 trials studying KEYTRUDA across a wide variety of cancers and treatment settings. The KEYTRUDA clinical program seeks to understand the role of KEYTRUDA across cancers and the factors that may predict a patient's likelihood of benefitting from treatment with KEYTRUDA, including exploring several different biomarkers.