Summary

James is injured! Hear about his favorite style of exercise (strength v cardio), and his no excuses attitude towards aches, pains, and niggles.

In this episode, Sapna and James discuss the Keynote 054 study, which examines the efficacy of adjuvant pembrolizumab (Pembro) versus placebo in patients with resected stage 3A to 3C melanoma. They explore the study's design, results, and implications for treatment decisions, particularly regarding toxicity management and the challenges of interpreting crossover designs. The discussion also touches on the significance of endocrine side effects and the importance of using minimal immunosuppression to maintain treatment efficacy.

Keywords

melanoma, adjuvant therapy, Keynote 054, toxicity management, immune activation, treatment decisions, PD-1 therapy, melanoma research, cancer treatment, clinical trials

Takeaways

Adjuvant Pembro shows significant RFS benefit compared to placebo.

Crossover design complicates treatment decisions in clinical practice.

Toxicity management is crucial for patient safety and treatment efficacy.

Endocrine side effects may indicate immune activation and treatment sensitivity.

Minimal immunosuppression is recommended to avoid blunting treatment effects.

The hazard ratio for benefit is similar across melanoma stages.

Real-world treatment decisions often deviate from trial protocols.

Understanding toxicity trends is essential for effective management.

Patients with endocrine side effects may not require high-dose steroids.

Keynote 054 highlights the need for careful interpretation of adjuvant therapy results.

Sound Bites

"Adjuvant Pembro for a year versus placebo."

"Significant RFS benefit in comparison with placebo."

"The now or later question is inevitable."

Chapters

00:00 Introduction and Quick Fire Questions

03:25 Keynote 054: Adjuvant Pembrolizumab in Stage 3 Melanoma

10:48 Managing Toxicity in the Adjuvant Setting