A Phase II Study of Pembrolizumab in Combination With Palliative Radiotherapy for Hormone Receptor-positive Metastatic Breast Cancer

This phase II single-arm study evaluated the efficacy of radiotherapy (RT) plus pembrolizumab in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative metastatic breast cancer. Palliative RT plus pembrolizumab did not demonstrate clinical activity in this heavily pretreated HR+ population. Future studies should investigate whether adjustments to the delivery of RT can produce beneficial clinical outcomes for patients with less pretreated HR+ metastatic breast cancer. Background: The purpose of this study was to investigate whether combining pembrolizumab with palliative radiation therapy (RT) improves outcomes in patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC). Patients and Methods: Eligible patients had HR+/human epidermal growth factor receptor 2-negative MBC; were candidates for RT to >= 1 bone, soft tissue, or lymph node lesion; and had >= 1 lesion outside the RT field. Patients received 200 mg pembrolizumab intravenously 2 to 7 days prior to RT and on day 1 of repeating 21-day cycles. RT was delivered to a previously unirradiated area in 5 treatments each of 4 Gy. The primary endpoint was objective response rate. The study used a 2-stage design: 8 women were enrolled into the first stage, and if at least 1 of 8 patients experienced an objective response, 19 more would be enrolled. Secondary endpoints included progressionfree survival, overall survival, and safety. Exploratory endpoints included association of overall response rate with programmed death-ligand 1 status and tumor-infiltrating lymphocytes. Results: Eight patients were enrolled in stage 1. The median age was 59 years, and the median prior lines of chemotherapy for metastatic disease was 2. There were no objective responses, and the study was closed to further accrual. The median progression-free survival was 1.4 months (95% confidence interval, 0.4-2.1 months), and the median overall survival was 2.9 months (95% confidence interval, 0.9-3.6 months). All-cause adverse events occurred in 87.5% of patients, including just 1 grade 3 event (elevation of aspartate aminotransferase). Conclusions: RT combined with pembrolizumab did not produce an objective response in patients with heavily pre-treated HR+ MBC. Future studies should consider alternative radiation dosing and fractionation in patients with less heavily pre-treated HR+ MBC. (C) 2020 Elsevier Inc. All rights reserved.