"I was delighted to take part in a clinical trial as it has the potential to really help others in the future.”
A trial of pembrolizumab for advanced cancer of the food pipe (oesophagus) KEYNOTE 181
This trial is for people with oesophageal cancer that has spread into the surrounding tissue (locally advanced) or to another part of the body (metastatic). It is also open to people with advanced gastro oesophageal junction cancer.
More about this trial
Chemotherapy is a common treatment for advanced oesophageal cancer. Unfortunately for some people their cancer continues to grow during treatment. For these people the doctor might try a different chemotherapy drug.
Researchers think that a drug called pembrolizumab might be better than chemotherapy for these people.
Pembrolizumab is a type of biological therapy called a monoclonal antibody. It helps the
In this trial pembrolizumab will be compared with standard chemotherapy for advanced oesophageal cancer:
The main aim of this trial is to find if pembrolizumab is a better treatment for advanced oesophageal cancer and advanced gastro oesophageal junction cancer.
Who can enter
The following bullet points list the entry conditions for this trial. Talk to your doctor or the trial team if you are unsure about any of these. They will be able to advise you.
You may be able to join this trial if all of the following apply:
- you have oesophageal cancer that is an adenocarcinoma or a squamous cell type or a gastro oesophageal junction cancer that is a type1 adenocarcinoma (if your gastro oesophageal junction cancer tested positive for
HER2your cancer must have continued to get worse while being treated with trastuzumab)
- your cancer has spread into the surrounding tissue (locally advanced) or to another part of the body (metastatic) and can’t be removed with surgery
- you are willing to have a small piece of tissue (
biopsy) taken from your cancer
- your cancer started to grow during your
first line of treatment
- you have an area of cancer that can be measured on a scan
- you have satisfactory blood test results
- you are able to do most things apart from heavy physical work (performance status 0 or 1)
- you are willing to use reliable contraception during treatment and for up to 6 months afterwards if there is any chance you or your partner could become pregnant
- you are at least 18 years old
You cannot join this trial if any of these apply:
- you have cancer spread to the brain or spine unless it has been treated, there are no symptoms and it has been stable for at least 4 weeks before joining the trial
- you have had any other anti cancer treatment within 2 weeks of joining the trial
- you have had an experimental drug as part of another clinical trial in the past month
- you have already had treatment with a similar drug
- you have taken part in another clinical trial of pembrolizumab
- you still have side effects from any previous treatment apart from mild hair loss or
- you have had another cancer in the past 5 years apart from successfully treated
non melanoma skin canceror in situ carcinomaof the cervix or breast
- you have an
autoimmune diseasethat has needed treatment in the past 2 years apart from taking medication to replace substances in the body such as thyroxine and insulin
immune systemisn’t working well
- you have had medication that affects your immune system such as steroids within the week of starting treatment in the trial
- you have had a
live vaccinewithin 30 days of starting treatment in the trial
- you have HIV, hepatitis B or hepatitis C
- you have an infection needing treatment such as antibiotics that reach the whole body (systemic treatment)
- you have a disease of the tissue surrounding the air sacs of the lung (interstitial lung disease) or inflammation of the lining of the air sacs (pneumonitis)
- you have any other medical or mental health condition that the trial team think could affect you taking part
- you are allergic or sensitive to any of the drugs or their ingredients used in this trial
- you are pregnant or breastfeeding
This is an international phase 3 trial. The researchers need about 18 people in the UK to take part.
This is a randomised trial. People taking part are put into 1 of 2 treatment groups by a computer. Neither you nor your doctor can choose which group you are in:
- doctors choice of
You can have up to 2 years of treatment (35 cycles) if it is helping and the side effects aren’t too bad.
After this you might be able to have another year of treatment if your cancer starts to grow again. Your doctor will talk to you about this.
For the standard chemotherapy your doctor can choose to give you one of the following:
All of these are given as a drip into a vein.
You have paclitaxel once a week for 3 weeks and then a week of not having it. This 4 week period is a cycle of treatment.
You have docetaxel once every 3 weeks. Each 3 week period is a cycle of treatment.
You have irinotecan once every 2 weeks. Each 2 week period is a cycle of treatment.
You continue to have treatment as long as it is helping and the side effects aren’t too bad.
Quality of life
The trial team will ask you to fill in a questionnaire for the first 7 cycles of treatment and then every 3 cycles of treatment for a year. The questions will ask you about how you are feeling and any side effects. This is a quality of life study.
The researchers will ask for some extra blood samples. They use these to
- find what happens to pembrolizumab in the body
- look for substances (
biomarkers) that might tell how well pembrolizumab is working
- look at the
genesin your cells to understand how they might affect how well your cancer responds to pembrolizumab
You see the doctor to have some tests before taking part. These tests include
During treatment you see the doctor at the start of each cycle of treatment for a physical examination and blood tests. You have a CT scan or MRI scan every 9 weeks.
When you finish treatment you see the doctor for the same tests you had at the start apart from the heart trace.
After treatment you either see the doctor or a member of the trial team will call you every 9 weeks until your cancer starts to get grow again. You will be asked to have a scan every 9 weeks.
If you stop treatment because your cancer has grown, then a member of the trial team will contact you by phone about every 12 weeks to see how you are doing.
The most common side effects of pembrolizumab are
- skin reactions including itchiness, rash and loss of colour
- tiredness and lack of energy
- loss of appetite
- a drop in red blood cells causing shortness of breath
- joint, back and stomach pain
- high temperature (fever)
- swelling of legs and feet
- feeling weak
- low amount of salt in the blood
- feeling or being sick
- diarrhoea and constipation
We have more information about pembrolizumab.
We have information on the side effects of
Your doctor will talk to you about the side effects of all the drugs before you agree to take part.
How to join a clinical trial
Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.
Dr Wasat Mansoor
Merck, Sharp & Dohme