A Phase 3 Study of Pembrolizumab versus Placebo for Previously Treated Patients from Asia with Hepatocellular Carcinoma: Health-Related Quality of Life Analysis from KEYNOTE-394
Shukui Qin, Weijia Fang, Zhenggang Ren, Shuangyan Ou, Ho Yeong Lim, Feng Zhang, Kin Chung Lee, Hye Jin Choi, Jiandong Tong, Min Tao, Aibing Xu, Ashley Cheng, Chang‐Hsien Lu, Chang-Fang Chiu, Mohamed Ibrahim A. Wahid, Shital Kamble, Josephine M. Norquist, Wenyan Zhong, Chen Li, Zhendong Chen
Abstract
<b><i>Introduction:</i></b> KEYNOTE-394 showed pembrolizumab significantly improved overall survival, progression-free survival, and objective response rate with manageable safety versus placebo for patients from Asia with previously treated advanced hepatocellular carcinoma. We present results on health-related quality of life (HRQoL). <b><i>Methods:</i></b> HRQoL was evaluated using the EORTC Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and EuroQol-5D-3L (EQ-5D-3L) questionnaires. Key HRQoL endpoints were least squares mean (LSM) score changes from baseline to week 12 and time to deterioration (TTD) for EORTC QLQ-C30 global health status (GHS)/QoL. <i>p</i> values were one-sided and nominal without adjustment for multiplicity. <b><i>Results:</i></b> The HRQoL population included patients randomly assigned to pembrolizumab (<i>n =</i> 298) and placebo (<i>n =</i> 152). From baseline to week 12, a greater decline in EORTC QLQ-C30 GHS/QoL score was observed with placebo (LSM, −8.4; 95% CI: −11.7 to −5.1) versus pembrolizumab (−4.0; 95% CI: −6.4 to −1.6; difference vs. placebo: 4.4; 95% CI: 0.5–8.4; nominal <i>p</i> = 0.0142). Similarly, a greater decline in the EQ-5D-3L visual analog scale score was observed with placebo (−6.9; 95% CI: −9.4 to −4.5) versus pembrolizumab (−2.7; 95% CI: −4.5 to −1.0; difference vs. placebo: 4.2; 95% CI: 1.2–7.2; nominal <i>p</i> = 0.0030). TTD in EORTC QLQ-C30 GHS/QoL score was similar between arms (hazard ratio, 0.85; 95% CI: 0.58–1.25; nominal <i>p</i> = 0.1993). <b><i>Conclusion:</i></b> Patients receiving placebo showed a greater decline in HRQoL than those receiving pembrolizumab. Combined with efficacy and safety data from KEYNOTE-394 and the global KEYNOTE-240 and KEYNOTE-224 trials, our data support the clinically meaningful benefit and manageable tolerability of pembrolizumab as second-line therapy for patients with advanced hepatocellular carcinoma.