Keytruda (pembrolizumab) vs Qinlock (ripretinib)

Keytruda (pembrolizumab) is an immune checkpoint inhibitor that works by blocking the PD-1 pathway, which helps the immune system to detect and fight cancer cells, and is commonly used for various types of cancers, including melanoma, lung cancer, and head and neck cancer. Qinlock (ripretinib) is a kinase inhibitor designed to treat advanced gastrointestinal stromal tumors (GIST) by inhibiting a range of kinases that drive the disease. The choice between Keytruda and Qinlock would depend on the specific type of cancer a patient has, as they are used to treat different conditions and operate through different mechanisms of action.

Difference between Keytruda and Qinlock

Metric	Keytruda (pembrolizumab)	Qinlock (ripretinib)
Generic name	Pembrolizumab	Ripretinib
Indications	Various types of cancers including melanoma, lung cancer, head and neck cancer, Hodgkin lymphoma, and others	Advanced gastrointestinal stromal tumor (GIST) in adult patients who have received prior treatment with 3 or more kinase inhibitors, including imatinib
Mechanism of action	Programmed death receptor-1 (PD-1) blocking antibody	Switch pocket kinase inhibitor targeting KIT and PDGFRA mutations
Brand names	Keytruda	Qinlock
Administrative route	Injection (IV)	Oral
Side effects	Fatigue, musculoskeletal pain, decreased appetite, pruritus, diarrhea, nausea, rash, pyrexia, cough, dyspnea, constipation, pain in extremity, and headache	Alopecia, fatigue, nausea, abdominal pain, constipation, myalgia, diarrhea, decreased appetite, palmar-plantar erythrodysesthesia syndrome, and vomiting
Contraindications	Patients with severe hypersensitivity to pembrolizumab or any of its excipients	Patients with severe hypersensitivity to ripretinib or any of its excipients
Drug class	Anti-PD-1 monoclonal antibody	Tyrosine kinase inhibitor
Manufacturer	Merck & Co.	Deciphera Pharmaceuticals

Efficacy

Keytruda (Pembrolizumab) Efficacy in Gastric Cancer

Keytruda, also known by its generic name pembrolizumab, is a monoclonal antibody that has been shown to be effective in the treatment of certain types of gastric cancer. It works by inhibiting the programmed death receptor-1 (PD-1) pathway, which is a mechanism that cancer cells can exploit to evade the immune system. By blocking this pathway, Keytruda can help the immune system to recognize and fight cancer cells. The efficacy of Keytruda in gastric cancer has been evaluated in several clinical trials, where it has been used as a monotherapy or in combination with other treatments.

One of the pivotal studies for Keytruda's approval in gastric cancer was the KEYNOTE-059 trial. In this study, patients with advanced gastric or gastroesophageal junction cancer who had previously received two or more lines of therapy were treated with pembrolizumab. The results demonstrated a meaningful objective response rate, with some patients experiencing significant tumor shrinkage. The duration of response varied, with some patients maintaining response for a prolonged period. However, it is important to note that not all patients respond to Keytruda, and the efficacy can be influenced by factors such as the expression level of PD-L1 in the tumor.

Qinlock (Ripretinib) Efficacy in Gastric Cancer

Qinlock, known generically as ripretinib, is a kinase inhibitor that targets a range of tyrosine kinases, including KIT and PDGFRα, which are known to be involved in the growth of gastrointestinal stromal tumors (GIST). While ripretinib has been approved for the treatment of advanced GIST, its use specifically in gastric cancer is less established. The efficacy of Qinlock in gastric cancer would likely be related to the presence of GIST, which can occur in the stomach. However, the use of ripretinib in typical adenocarcinoma of the stomach (the most common type of gastric cancer) has not been a primary focus of clinical trials, and thus its efficacy in this context is not well-documented.

For patients with GIST, Qinlock has been studied in the INVICTUS trial, which included patients with advanced GIST who had previously received treatment with other tyrosine kinase inhibitors. Ripretinib demonstrated a significant improvement in progression-free survival compared to placebo, and it also showed an overall survival benefit, although the data was not mature at the time of the initial analysis. While these results are promising for patients with GIST, it is crucial to differentiate between GIST and other forms of gastric cancer when considering the efficacy of Qinlock, as its approval and established efficacy are specific to GIST and not gastric cancer in general.

Regulatory Agency Approvals

Keytruda

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Therapeutic Goods Administration (TGA), Australia
Medsafe (NZ)

Qinlock

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Therapeutic Goods Administration (TGA), Australia

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