OnCo
trialsTrialPositive

KEYNOTE-590

Added immunotherapy to first-line chemotherapy for all types of oesophageal cancer, with a survival benefit that held at five years.

OS 12.4 vs 9.8 months overall (HR 0.73); 13.9 vs 8.8 months in PD-L1 CPS ≥10 (HR 0.62). Five-year follow-up (ESMO Open 2025): OS HR 0.72. FDA approval March 2021 for all patients; EMA restricted to CPS ≥10. Benefit in PD-L1-negative disease is uncertain.

Setting
First-line advanced oesophageal cancer (squamous and adenocarcinoma) and Siewert I GEJ: pembrolizumab + cisplatin/5-FU vs chemotherapy
Phase
Phase 3
Sponsor
Merck
Registry
Headline result
OS 12.4 vs 9.8 months (HR 0.73); 5-year OS HR 0.72.
Reported
2020
Enrolled
749
Replication
Replicated by CheckMate 648, RATIONALE-306, ESCORT-1st, JUPITER-06, and ORIENT-15 in squamous disease.

Outcomes

2top
In plain words
What these results mean for people, not percentages
749 people took part
Overall survival, all patientsprimarysurvival endpoint
  • Median 12.4 vs 9.8 months with Pembrolizumab + chemotherapy compared with Placebo + chemotherapy; about 2.6 months longer for half the group.
  • A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
  • Put another way, the treated group had about 27 percent lower chance of the event at any given time (hazard ratio 0.73).
Overall survival at 5-year follow-upsurvival endpoint
  • The treated group had about 28 percent lower chance of the event at any given time (hazard ratio 0.72).
  • The absolute difference, how many more people out of 100 were helped, is not reported here.
Be careful
  • Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
  • These results apply to the people the trial enrolled: First-line advanced oesophageal cancer (squamous and adenocarcinoma) and Siewert I GEJ: pembrolizumab + cisplatin/5-FU vs chemotherapy. People in a different situation may not see the same effect.

Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.

749 participants enrolled.

Overall survival, all patientsprimary
HR 0.73
Pembrolizumab + chemotherapy
12.4 mo
Placebo + chemotherapy
9.8 mo
Source
Overall survival at 5-year follow-up
HR 0.72 (0.62–0.84)

Numbers not yet public.

Source
EndpointArmnValueHR (95% CI)pSource
Overall survival, all patientsprimaryPembrolizumab + chemotherapy37312.4 months0.73link
Placebo + chemotherapy3769.8 months
Overall survival at 5-year follow-upPembrolizumab + chemotherapy0.72 (0.62–0.84)link
Placebo + chemotherapy
Replication
Replicated by CheckMate 648, RATIONALE-306, ESCORT-1st, JUPITER-06, and ORIENT-15 in squamous disease.

Connected

4top