Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with advanced, PD-L1-positive papillary or follicular thyroid cancer

BMC Cancer. 2019 Mar 4;19(1):196. doi: 10.1186/s12885-019-5380-3.


Background: Treatment options for advanced thyroid cancer refractory to standard therapies are limited. The safety and efficacy of pembrolizumab were evaluated in patients with advanced differentiated thyroid cancer expressing programmed death ligand 1 (PD-L1).

Methods: Patients with advanced thyroid cancer were enrolled in the nonrandomized, phase Ib KEYNOTE-028 trial conducted to evaluate safety and antitumor activity of the anti-programmed death 1 (PD-1) antibody pembrolizumab in advanced solid tumors. Key eligibility criteria were advanced papillary or follicular thyroid cancer, failure of standard therapy, and PD-L1 expression in tumor or stroma cells (assessed by immunohistochemistry). Pembrolizumab 10 mg/kg was administered every 2 weeks up to 24 months or until confirmed progression or intolerable toxicity. The primary endpoint was objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors, version 1.1.

Results: Twenty-two patients were enrolled: median age was 61 years; 59% were women; and 68% had papillary carcinoma. Median follow-up was 31 months (range, 7-34 months). Treatment-related adverse events were observed in 18 (82%) patients; those occurring in ≥15% of patients were diarrhea (n = 7) and fatigue (n = 4). One grade ≥ 3 treatment-related adverse event occurred (colitis, grade 3); no treatment-related discontinuations or deaths occurred. Two patients had confirmed partial response, for an ORR of 9% (95% confidence interval [CI], 1-29%); response duration was 8 and 20 months. Median progression-free survival was 7 months (95% CI, 2-14 months); median overall survival was not reached (95% CI, 22 months to not reached).

Conclusions: Results of this phase Ib proof-of-concept study suggest that pembrolizumab has a manageable safety profile and demonstrate evidence of antitumor activity in advanced differentiated thyroid cancer in a minority of patients treated. Further analyses are necessary to confirm these findings.

Trial registration: identifier: NCT02054806 . Registered 4 February 2014.

Keywords: Anti–PD-1; Immunotherapy; PD-1; PD-L1; Pembrolizumab; Thyroid cancer.

Publication types

  • Clinical Trial, Phase I

MeSH terms

  • Adenocarcinoma, Follicular / drug therapy*
  • Adenocarcinoma, Follicular / metabolism
  • Adult
  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antineoplastic Agents, Immunological / therapeutic use*
  • B7-H1 Antigen / metabolism
  • Colitis / chemically induced
  • Diarrhea / chemically induced
  • Fatigue / chemically induced
  • Female
  • Humans
  • Male
  • Middle Aged
  • Progression-Free Survival
  • Proof of Concept Study
  • Response Evaluation Criteria in Solid Tumors
  • Thyroid Cancer, Papillary / drug therapy*
  • Thyroid Cancer, Papillary / metabolism
  • Thyroid Neoplasms / drug therapy*
  • Thyroid Neoplasms / metabolism
  • Treatment Outcome
  • Young Adult


  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • B7-H1 Antigen
  • CD274 protein, human
  • pembrolizumab

Supplementary concepts

  • Thyroid cancer, follicular

Associated data