FDA Approves Expanded Monotherapy Label for Merck’s KEYTRUDA® (pembrolizumab)

KEYTRUDA Now Approved for First-Line Treatment of Patients with Stage
III NSCLC Who Are Not Candidates for Surgical Resection or Definitive
Chemoradiation, or Metastatic NSCLC, and Whose Tumors Express PD-L1 (TPS
≥1%), with No EGFR or ALK Genomic Tumor Aberrations

KENILWORTH, N.J.–(BUSINESS WIRE)–lt;a href="https://twitter.com/search?q=%24MRK&src=ctag" target="_blank"gt;$MRKlt;/agt; lt;a href="https://twitter.com/hashtag/MRK?src=hash" target="_blank"gt;#MRKlt;/agt;–Merck (NYSE:MRK), known as MSD outside the United States and Canada,
today announced that the U.S. Food and Drug Administration (FDA) has
approved an expanded label for KEYTRUDA, Merck’s anti-PD-1 therapy, as
monotherapy for the first-line treatment of patients with stage III
non-small cell lung cancer (NSCLC) who are not candidates for surgical
resection or definitive chemoradiation, or metastatic NSCLC, and whose
tumors express PD-L1 (tumor proportion score [TPS] ≥1%) as determined by
an FDA-approved test, with no EGFR or ALK genomic tumor aberrations. The
approval is based on results from the Phase 3 KEYNOTE-042 trial, in
which overall survival (OS) was sequentially tested as part of a
pre-specified analysis plan. In the trial, KEYTRUDA monotherapy
demonstrated a statistically significant improvement in OS compared with
chemotherapy alone in patients whose tumors expressed PD-L1 with a TPS
≥50%, with a TPS ≥20%, and then in the entire study population (TPS ≥1%).

“This expanded first-line indication now makes KEYTRUDA monotherapy an
option for more patients with non-small cell lung cancer, including
those for whom combination therapy may not be appropriate,” said Dr.
Jonathan Cheng, vice president, oncology clinical research, Merck
Research Laboratories.

Immune-mediated adverse reactions, which may be severe or fatal, can
occur with KEYTRUDA, including pneumonitis, colitis, hepatitis,
endocrinopathies, nephritis, severe skin reactions, solid organ
transplant rejection, and complications of allogeneic hematopoietic stem
cell transplantation (HSCT). Based on the severity of the adverse
reaction, KEYTRUDA should be withheld or discontinued and
corticosteroids administered if appropriate. KEYTRUDA can also cause
severe or life-threatening infusion-related reactions. Based on its
mechanism of action, KEYTRUDA can cause fetal harm when administered to
a pregnant woman. For more information, see “Selected Important Safety
Information” below.

“The KEYNOTE-042 trial demonstrated a survival benefit with KEYTRUDA
monotherapy across histologies in certain patients with stage III or
metastatic non-small cell lung cancer whose tumors expressed PD-L1 in at
least 1% of tumor cells,” said Dr. Gilberto Lopes, associate director
for global oncology at the Sylvester Comprehensive Cancer Center at the
University of Miami. “As a practicing oncologist, having additional
options available for patients is important in the rapidly evolving
treatment landscape for lung cancer, which remains the leading cause of
cancer death in the United States.”

KEYTRUDA was the first anti-PD-1 therapy in metastatic NSCLC approved in
the first-line setting as combination therapy or monotherapy.

About KEYNOTE-042

The approval was based on data from the KEYNOTE-042 trial, a randomized,
multi-center, open-label, active-controlled trial in patients with stage
III NSCLC who were not candidates for surgical resection or definitive
chemoradiation, or metastatic NSCLC, and whose tumors expressed PD-L1
(TPS ≥1%) and who had not received prior systemic treatment for
metastatic NSCLC. Patients with EGFR or ALK genomic tumor aberrations;
autoimmune disease that required systemic therapy within two years of
treatment; a medical condition that required immunosuppression; or who
had received more than 30 Gy of radiation in the thoracic region within
26 weeks prior to initiation of study treatment were ineligible.

The study enrolled 1,274 patients who were randomized (1:1) to receive
KEYTRUDA 200 mg intravenously every three weeks (n=637) or
investigator’s choice of either of the following chemotherapy regimens
(n=637):

• Pemetrexed 500 mg/m² every three weeks and carboplatin AUC
  5 to 6 mg/mL/min every three weeks on Day 1 for a maximum of six
  cycles followed by optional pemetrexed 500 mg/m² every
  three weeks for patients with nonsquamous histologies; or
• Paclitaxel 200 mg/m² every three weeks and carboplatin AUC
  5 to 6 mg/mL/min every three weeks on Day 1 for a maximum of six
  cycles followed by optional pemetrexed 500 mg/m² every
  three weeks for patients with nonsquamous histologies

Treatment with KEYTRUDA continued until RECIST v1.1 (modified to follow
a maximum of 10 target lesions and a maximum of 5 target lesions per
organ)-defined progression of disease, unacceptable toxicity, or a
maximum of 24 months. The main efficacy outcome measure was OS in the
subgroup of patients with TPS ≥50% NSCLC, the subgroup of patients with
TPS ≥20% NSCLC, and the overall population with TPS ≥1% NSCLC.
Additional efficacy outcome measures were progression-free survival
(PFS) and overall response rate (ORR) in the subgroup of patients with
TPS ≥50% NSCLC, the subgroup of patients with TPS ≥20% NSCLC, and the
overall population with TPS ≥1% NSCLC as assessed by a blinded
independent central radiologists’ (BICR) review according to RECIST
v1.1, modified to follow a maximum of 10 target lesions and a maximum of
five target lesions per organ.

Efficacy Results from KEYNOTE-042

		TPS ≥1%				TPS ≥50%
Endpoint		KEYTRUDA 200 mg every 3 weeks n=637		Chemotherapy n=637		KEYTRUDA 200 mg every 3 weeks n=299		Chemotherapy n=300
OS
Number of events (%)		371 (58%)		438 (69%)		157 (53%)		199 (66%)
Median in months (95% CI)		16.7 (13.9-19.7)		12.1 (11.3-13.3)		20.0 (15.4-24.9)		12.2 (10.4-14.2)
Hazard ratio (HR)* (95% CI)		0.81 (0.71-0.93)				0.69 (0.56-0.85)
p-Value†		0.0036				0.0006
PFS
Number of events (%)		507 (80%)		506 (79%)		221 (74%)		233 (78%)
Median in months (95% CI)		5.4 (4.3-6.2)		6.5 (6.3-7.0)		7.1 (5.9-9.0)		6.4 (6.1-6.9)
HR*,‡ (95% CI)		1.07 (0.94-1.21)				0.81 (0.67-0.99)
p-Value†		–‡				NS§
Objective Response Rate
ORR‡ (95% CI)		27% (24-31)		27% (23-30)		39% (33.9-45.3)		32% (26.8-37.6)
Complete response rate		0.5%		0.5%		0.7%		0.3%
Partial response rate		27%		26%		39%		32%
Duration of Response
% with duration ≥ 12 months¶		47%		16%		42%		17%
% with duration ≥ 18 months¶		26%		6%		25%		5%

* Based on the stratified Cox proportional hazard model
^†
Based on a stratified log-rank test; compared to a p-Value boundary of
0.0291
^‡ Not evaluated for statistical significance as a
result of the sequential testing procedure for the secondary endpoints
§
Not significant compared to a p-Value boundary of 0.0291
^¶
Based on observed duration of response

The results of all efficacy outcome measures in the subgroup of patients
with PD-L1 TPS ≥20% NSCLC were intermediate between the results of those
with PD-L1 TPS ≥1% and those with PD-L1 TPS ≥50%. In a pre-specified
exploratory subgroup analysis for patients with TPS 1-49% NSCLC, the
median OS was 13.4 months (95% CI, 10.7-18.2) for the KEYTRUDA group and
12.1 months (95% CI, 11.0-14.0) in the chemotherapy group, with an HR of
0.92 (95% CI, 0.77-1.11).

In KEYNOTE-042, the safety of KEYTRUDA was investigated in patients with
PD-L1 expressing, previously untreated stage III NSCLC who were not
candidates for surgical resection or definitive chemoradiation, or
metastatic NSCLC. KEYTRUDA was discontinued for adverse reactions in 19%
of 636 patients. The most common adverse reactions resulting in
permanent discontinuation of KEYTRUDA were pneumonitis (3.0%), death due
to unknown cause (1.6%), and pneumonia (1.4%). Adverse reactions leading
to interruption of KEYTRUDA occurred in 33% of patients; the most common
adverse reactions or laboratory abnormalities leading to interruption of
KEYTRUDA (≥2%) were pneumonitis (3.1%), pneumonia (3.0%), hypothyroidism
(2.2%), and increased ALT (2.0%). The most frequent (≥2%) serious
adverse reactions were pneumonia (7%), pneumonitis (3.9%), pulmonary
embolism (2.4%), and pleural effusion (2.2%). The most common adverse
reaction (≥20%) with KEYTRUDA was fatigue (25%).

About KEYTRUDA^® (pembrolizumab) Injection,
100mg

KEYTRUDA is an anti-PD-1 therapy that works by increasing the ability of
the body’s immune system to help detect and fight tumor cells. KEYTRUDA
is a humanized monoclonal antibody that blocks the interaction between
PD-1 and its ligands, PD-L1 and PD-L2, thereby activating T lymphocytes
which may affect both tumor cells and healthy cells.

Merck has the industry’s largest immuno-oncology clinical research
program. There are currently more than 950 trials studying KEYTRUDA
across a wide variety of cancers and treatment settings. The KEYTRUDA
clinical program seeks to understand the role of KEYTRUDA across cancers
and the factors that may predict a patient’s likelihood of benefitting
from treatment with KEYTRUDA, including exploring several different
biomarkers.

KEYTRUDA^® (pembrolizumab) Indications and
Dosing

Melanoma

KEYTRUDA is indicated for the treatment of patients with unresectable or
metastatic melanoma. The recommended dose of KEYTRUDA in patients with
unresectable or metastatic melanoma is 200 mg administered as an
intravenous infusion over 30 minutes every three weeks until disease
progression or unacceptable toxicity.

KEYTRUDA is indicated for the adjuvant treatment of patients with
melanoma with involvement of lymph node(s) following complete resection.
The recommended dose of KEYTRUDA for the adjuvant treatment of adult
patients with melanoma is 200 mg administered as an intravenous infusion
over 30 minutes every three weeks until disease recurrence, unacceptable
toxicity, or for up to 12 months in patients without disease recurrence.

Lung Cancer

KEYTRUDA, in combination with pemetrexed and platinum chemotherapy, is
indicated for the first-line treatment of patients with metastatic
nonsquamous non-small cell lung cancer (NSCLC), with no EGFR or ALK
genomic tumor aberrations.

KEYTRUDA, in combination with carboplatin and either paclitaxel or
paclitaxel protein-bound, is indicated for the first-line treatment of
patients with metastatic squamous NSCLC.

KEYTRUDA, as a single agent, is indicated for the first-line treatment
of patients with stage III NSCLC who are not candidates for surgical
resection or definitive chemoradiation, or metastatic NSCLC, and whose
tumors express PD-L1 [tumor proportion score (TPS) ≥1%] as determined by
an FDA-approved test, with no EGFR or ALK genomic tumor aberrations.

KEYTRUDA, as a single agent, is indicated for the treatment of patients
with metastatic NSCLC whose tumors express PD-L1 (TPS ≥1%) as determined
by an FDA-approved test, with disease progression on or after
platinum-containing chemotherapy. Patients with EGFR or ALK genomic
tumor aberrations should have disease progression on FDA-approved
therapy for these aberrations prior to receiving KEYTRUDA.

In NSCLC, the recommended dose of KEYTRUDA is 200 mg administered as an
intravenous infusion over 30 minutes every three weeks until disease
progression, unacceptable toxicity, or up to 24 months in patients
without disease progression.

When administering KEYTRUDA in combination with chemotherapy, KEYTRUDA
should be administered prior to chemotherapy when given on the same day.
See also the Prescribing Information for the chemotherapy agents
administered in combination with KEYTRUDA, as appropriate.

Head and Neck Cancer

KEYTRUDA is indicated for the treatment of patients with recurrent or
metastatic head and neck squamous cell carcinoma (HNSCC) with disease
progression on or after platinum-containing chemotherapy. This
indication is approved under accelerated approval based on tumor
response rate and durability of response. Continued approval for this
indication may be contingent upon verification and description of
clinical benefit in the confirmatory trials. In HNSCC, KEYTRUDA 200 mg
is administered as an intravenous infusion over 30 minutes every three
weeks until disease progression, unacceptable toxicity, or up to 24
months in patients without disease progression.

Classical Hodgkin Lymphoma

KEYTRUDA is indicated for the treatment of adult and pediatric patients
with refractory classical Hodgkin lymphoma (cHL), or who have relapsed
after 3 or more prior lines of therapy. This indication is approved
under accelerated approval based on tumor response rate and durability
of response. Continued approval for this indication may be contingent
upon verification and description of clinical benefit in the
confirmatory trials. In adults with cHL, KEYTRUDA 200 mg is administered
as an intravenous infusion over 30 minutes every three weeks until
disease progression or unacceptable toxicity, or up to 24 months in
patients without disease progression. In pediatric patients with cHL,
KEYTRUDA is administered as an intravenous infusion over 30 minutes at a
dose of 2 mg/kg (up to a maximum of 200 mg) every three weeks until
disease progression or unacceptable toxicity, or up to 24 months in
patients without disease progression.

Primary Mediastinal Large B-Cell Lymphoma

KEYTRUDA is indicated for the treatment of adult and pediatric patients
with refractory primary mediastinal large B-cell lymphoma (PMBCL), or
who have relapsed after 2 or more prior lines of therapy. This
indication is approved under accelerated approval based on tumor
response rate and durability of response. Continued approval for this
indication may be contingent upon verification and description of
clinical benefit in confirmatory trials. KEYTRUDA is not recommended for
the treatment of patients with PMBCL who require urgent cytoreductive
therapy.

In adults with PMBCL, KEYTRUDA 200 mg is administered as an intravenous
infusion over 30 minutes every three weeks until disease progression,
unacceptable toxicity, or up to 24 months in patients without disease
progression. In pediatric patients with PMBCL, KEYTRUDA is administered
as an intravenous infusion over 30 minutes at a dose of 2 mg/kg (up to a
maximum of 200 mg) every three weeks until disease progression or
unacceptable toxicity, or up to 24 months in patients without disease
progression.

Urothelial Carcinoma

KEYTRUDA is indicated for the treatment of patients with locally
advanced or metastatic urothelial carcinoma (mUC) who are not eligible
for cisplatin-containing chemotherapy and whose tumors express PD-L1
[combined positive score (CPS) ≥10] as determined by an FDA-approved
test, or in patients who are not eligible for any platinum-containing
chemotherapy regardless of PD-L1 status. This indication is approved
under accelerated approval based on tumor response rate and duration of
response. Continued approval for this indication may be contingent upon
verification and description of clinical benefit in the confirmatory
trials.

KEYTRUDA is indicated for the treatment of patients with locally
advanced or metastatic urothelial carcinoma (mUC) who have disease
progression during or following platinum-containing chemotherapy or
within 12 months of neoadjuvant or adjuvant treatment with
platinum-containing chemotherapy.

In locally advanced or metastatic urothelial carcinoma, KEYTRUDA 200 mg
is administered as an intravenous infusion over 30 minutes every three
weeks until disease progression or unacceptable toxicity, or up to 24
months in patients without disease progression.

Microsatellite Instability-High (MSI-H) Cancer

KEYTRUDA is indicated for the treatment of adult and pediatric patients
with unresectable or metastatic microsatellite instability-high (MSI-H)
or mismatch repair deficient (dMMR)

• solid tumors that have progressed following prior treatment and who
  have no satisfactory alternative treatment options, or
• colorectal cancer that has progressed following treatment with
  fluoropyrimidine, oxaliplatin, and irinotecan.

This indication is approved under accelerated approval based on tumor
response rate and durability of response. Continued approval for this
indication may be contingent upon verification and description of
clinical benefit in the confirmatory trials. The safety and
effectiveness of KEYTRUDA in pediatric patients with MSI-H central
nervous system cancers have not been established.

In adult patients with MSI-H cancer, KEYTRUDA 200 mg is administered as
an intravenous infusion over 30 minutes every three weeks until disease
progression, unacceptable toxicity, or up to 24 months in patients
without disease progression. In pediatric patients with MSI-H cancer,
KEYTRUDA is administered as an intravenous infusion over 30 minutes at a
dose of 2 mg/kg (up to a maximum of 200 mg) every three weeks until
disease progression or unacceptable toxicity, or up to 24 months in
patients without disease progression.

Gastric Cancer

KEYTRUDA is indicated for the treatment of patients with recurrent
locally advanced or metastatic gastric or gastroesophageal junction
(GEJ) adenocarcinoma whose tumors express PD-L1 (CPS ≥1) as determined
by an FDA-approved test, with disease progression on or after two or
more prior lines of therapy including fluoropyrimidine- and
platinum-containing chemotherapy and if appropriate, HER2/neu-targeted
therapy. This indication is approved under accelerated approval based on
tumor response rate and durability of response. Continued approval for
this indication may be contingent upon verification and description of
clinical benefit in the confirmatory trials. The recommended dose of
KEYTRUDA is 200 mg as an intravenous infusion over 30 minutes every
three weeks until disease progression, unacceptable toxicity, or up to
24 months in patients without disease progression.

Cervical Cancer

KEYTRUDA is indicated for the treatment of patients with recurrent or
metastatic cervical cancer with disease progression on or after
chemotherapy whose tumors express PD-L1 (CPS ≥1) as determined by an
FDA-approved test. This indication is approved under accelerated
approval based on tumor response rate and durability of response.
Continued approval for this indication may be contingent upon
verification and description of clinical benefit in the confirmatory
trials. The recommended dose of KEYTRUDA is 200 mg as an intravenous
infusion over 30 minutes every three weeks until disease progression,
unacceptable toxicity or up to 24 months in patients without disease
progression.

Hepatocellular Carcinoma

KEYTRUDA is indicated for the treatment of patients with hepatocellular
carcinoma (HCC) who have been previously treated with sorafenib. This
indication is approved under accelerated approval based on tumor
response rate and durability of response. Continued approval for this
indication may be contingent upon verification and description of
clinical benefit in the confirmatory trials. The recommended dose of
KEYTRUDA is 200 mg as an intravenous infusion over 30 minutes every
three weeks until disease progression, unacceptable toxicity, or up to
24 months in patients without disease progression.

Merkel Cell Carcinoma

KEYTRUDA is indicated for the treatment of adult and pediatric patients
with recurrent locally advanced or metastatic Merkel cell carcinoma.
This indication is approved under accelerated approval based on tumor
response rate and durability of response. Continued approval for this
indication may be contingent upon verification and description of
clinical benefit in the confirmatory trials. The recommended dose of
KEYTRUDA in adults is 200 mg administered as an intravenous infusion
over 30 minutes every three weeks until disease progression,
unacceptable toxicity, or up to 24 months in patients without disease
progression. The recommended dose of KEYTRUDA in pediatric patients is 2
mg/kg (up to a maximum of 200 mg), administered as an intravenous
infusion over 30 minutes every three weeks until disease progression or
unacceptable toxicity, or up to 24 months in patients without disease
progression.

Selected Important Safety Information for KEYTRUDA

Immune-Mediated Pneumonitis

KEYTRUDA can cause immune-mediated pneumonitis, including fatal cases.
Pneumonitis occurred in 3.4% (94/2799) of patients with various cancers
receiving KEYTRUDA, including Grade 1 (0.8%), 2 (1.3%), 3 (0.9%), 4
(0.3%), and 5 (0.1%). Pneumonitis occurred in 8.2% (65/790) of NSCLC
patients receiving KEYTRUDA as a single agent, including Grades 3-4 in
3.2% of patients, and occurred more frequently in patients with a
history of prior thoracic radiation (17%) compared to those without
(7.7%).

Monitor patients for signs and symptoms of pneumonitis. Evaluate
suspected pneumonitis with radiographic imaging. Administer
corticosteroids for Grade 2 or greater pneumonitis. Withhold KEYTRUDA
for Grade 2; permanently discontinue KEYTRUDA for Grade 3 or 4 or
recurrent Grade 2 pneumonitis.

Immune-Mediated Colitis

KEYTRUDA can cause immune-mediated colitis. Colitis occurred in 1.7%
(48/2799) of patients receiving KEYTRUDA, including Grade 2 (0.4%), 3
(1.1%), and 4 (<0.1%). Monitor patients for signs and symptoms of
colitis. Administer corticosteroids for Grade 2 or greater colitis.
Withhold KEYTRUDA for Grade 2 or 3; permanently discontinue KEYTRUDA for
Grade 4 colitis.

Immune-Mediated Hepatitis

KEYTRUDA can cause immune-mediated hepatitis. Hepatitis occurred in 0.7%
(19/2799) of patients receiving KEYTRUDA, including Grade 2 (0.1%), 3
(0.4%), and 4 (<0.1%). Monitor patients for changes in liver function.
Administer corticosteroids for Grade 2 or greater hepatitis and, based
on severity of liver enzyme elevations, withhold or discontinue KEYTRUDA.

Immune-Mediated Endocrinopathies

KEYTRUDA can cause hypophysitis, thyroid disorders, and type 1 diabetes
mellitus. Hypophysitis occurred in 0.6% (17/2799) of patients, including
Grade 2 (0.2%), 3 (0.3%), and 4 (<0.1%). Hypothyroidism occurred in 8.5%
(237/2799) of patients, including Grade 2 (6.2%) and 3 (0.1%). The
incidence of new or worsening hypothyroidism was higher in patients with
HNSCC, occurring in 15% (28/192) of patients. Hyperthyroidism occurred
in 3.4% (96/2799) of patients, including Grade 2 (0.8%) and 3 (0.1%),
and thyroiditis occurred in 0.6% (16/2799) of patients, including Grade
2 (0.3%). Type 1 diabetes mellitus, including diabetic ketoacidosis,
occurred in 0.2% (6/2799) of patients.

Monitor patients for signs and symptoms of hypophysitis (including
hypopituitarism and adrenal insufficiency), thyroid function (prior to
and periodically during treatment), and hyperglycemia. For hypophysitis,
administer corticosteroids and hormone replacement as clinically
indicated. Withhold KEYTRUDA for Grade 2 and withhold or discontinue for
Grade 3 or 4 hypophysitis. Administer hormone replacement for
hypothyroidism and manage hyperthyroidism with thionamides and
beta-blockers as appropriate. Withhold or discontinue KEYTRUDA for Grade
3 or 4 hyperthyroidism. Administer insulin for type 1 diabetes, and
withhold KEYTRUDA and administer antihyperglycemics in patients with
severe hyperglycemia.

Immune-Mediated Nephritis and Renal Dysfunction

KEYTRUDA can cause immune-mediated nephritis. Nephritis occurred in 0.3%
(9/2799) of patients receiving KEYTRUDA, including Grade 2 (0.1%), 3
(0.1%), and 4 (<0.1%) nephritis. Nephritis occurred in 1.7% (7/405) of
patients receiving KEYTRUDA in combination with pemetrexed and platinum
chemotherapy. Monitor patients for changes in renal function. Administer
corticosteroids for Grade 2 or greater nephritis. Withhold KEYTRUDA for
Grade 2; permanently discontinue for Grade 3 or 4 nephritis.

Immune-Mediate

Contacts

Media:
Pamela Eisele
(267) 305-3558

Justine Moore
(347)
281-3754

Investors:
Teri Loxam
(908) 740-1986

Michael
DeCarbo
(908) 740-1807

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