Mali Barbi, Medical Oncologist at Northwell Health, shared on X:
“Today I reviewed KEYNOTE-B96 with my fellow. Two questions.
Why is this the first ICI that works in ovarian cancer, and where do I sequence it.
The first is design, not the drug. B96 pairs Pembrolizumab with an active backbone, weekly paclitaxel plus bevacizumab, and bevacizumab was not randomized. 73% got it by investigator choice. So the trial cannot separate the Pembrolizumab effect from a Pembrolizumab plus bevacizumab one. The PFS benefit shows up regardless of PD-L1. We may be crediting the checkpoint for what the backbone and bevacizumab did.
The second question is where I get stuck.
In platinum-resistant disease I test FRα first. If positive, that is mirvetuximab, OS 16.9 vs 13.3, HR 0.68. If negative, relacorilant plus nab-paclitaxel, no biomarker needed, OS 16.0 vs 11.9, HR 0.65. Or a trial. B96 is labeled at 1 to 2 prior lines, CPS≥1, with a 1.1 month PFS gain and added immune toxicity.
Every patient who fits it already has a cleaner, better-targeted option ahead of it. First positive ICI in ovarian, unclean attribution, and no slot to sequence it. ”
Title: Pembrolizumab plus weekly paclitaxel in platinum-resistant recurrent ovarian cancer (ENGOT-ov65/KEYNOTE-B96): a multicentre, randomised, double-blind, phase 3 study
Authors: Nicoletta Colombo, Emese Zsiros, Gabriella Parma, Eliana Rulli, Alexandra Sebastianelli, Mariusz Bidzinski, Carlos Gallardo, Emad Matanes, Kosei Hasegawa, Fatih Kose, Manuel Magallanes-Maciel, Rebecca A. Herbertson, Sumitra Ananda, Judith R. Kroep, Andreia Cristina de Melo, Philip R. Debruyne, Jae-Weon Kim, Jalid Sehouli, Marc-Edy Pierre, Sakari Hietanen, Claudio Zamagni, Xin Lu, Bradley J. Monk, Robert L. Coleman, Xuan Peng, Karin Yamada, Agata M. Bogusz, Thibault De La Motte Rouge, and Xiaohua Wu
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