PEMMELA: a promising regimen at the expense of toxicity
Mené aux Pays-Bas sur 38 patients atteints d'un mésothéliome pleural (âge médian : 71 ans ; durée médiane de suivi : 17,7 mois), cet essai de phase II évalue l'efficacité, du point de vue du taux de réponse objective, et la toxicité d'un traitement de deuxième ou troisième ligne combinant pembrolizumab et lenvatinib après l'échec d'une chimiothérapie à base de sels de platine
Pleural mesothelioma is an uncommon malignancy with few treatment options. 1 In The Lancet Oncology, Li-Anne H Douma and colleagues 2 report on the PEMMELA study, which is an admirable effort to expand the effective systemic therapy options for patients with pleural mesothelioma. 2 This single-arm phase 2 study in immunotherapy-naive patients with progressive disease trialled the combination of pembrolizumab and lenvatinib, an oral multi-kinase inhibitor at 20 mg once per day. Lenvatinib has been postulated to restimulate the immune response to overcome immunotherapy resistance and has been trialled at various doses from 18 mg to 24mg monotherapy in hepatocellular carcinoma and thyroid malignancy, a 20 mg combination with pembrolizumab in renal and endometrial carcinoma, and an 8 mg dose in combination with chemotherapy and pembrolizumab in lung cancer. 3 Given the efficacy of anti-angiogenic agents against mesothelioma, this combination approach has a sound biological rationale
The Lancet Oncology 2023