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ESMO 2019: Combination Immunotherapy Versus Chemotherapy in Advanced Lung Cancer

By: Hillary Ojeda
Posted: Friday, October 4, 2019

In the final analysis of Part 1 of the CheckMate 227 trial, Solange Peters, MD, PhD, of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, and colleagues found that the combination of nivolumab and low-dose ipilimumab improved overall survival in some patients with advanced non–small cell lung cancer (NSCLC) compared with chemotherapy. The authors presented these findings at the European Society for Medical Oncology (ESMO) Congress 2019 in Barcelona (Abstract LBA4_PR) and indicated further studies are needed to find the most efficient treatment for each patient. 

“In my opinion, these data are practice-changing,” stated Dr. Peters in an ESMO press release. “CheckMate-277 is the first trial showing that the combination of nivolumab and ipilimumab prolongs survival as compared to chemotherapy in treatment-naive patients with metastatic NSCLC.”

A total of 1,739 patients with stage IV or recurrent NSCLC, who received no previous treatment, were enrolled in the study. Depending on their PD-L1 expression, they were randomly selected for one of several treatments: nivolumab plus ipilimumab, nivolumab, histology-based chemotherapy, nivolumab plus chemotherapy, or chemotherapy. Patients with PD-L1 expression ≥ 1% received either nivolumab at 3 mg/kg every 2 weeks plus ipilimumab at 1 mg/kg every 6 weeks; nivolumab at 240 mg every 2 weeks, or chemotherapy. Patients with PD-L1 expression < 1% received either nivolumab at 3 mg/kg every 2 weeks plus ipilimumab at 1 mg/kg every 6 weeks, nivolumab at 360 mg every 3 weeks plus chemotherapy, or chemotherapy. Treatment continued until disease progression, advanced toxicity, or 2 years of immunotherapy.

The minimum follow-up was 29.3 months. Objective response rates, progression-free survival, and overall survival were all improved in patients treated with nivolumab plus ipilimumab compared with patients who received chemotherapy. In addition, an overall survival benefit was observed in those with PD-L1 expression less than 1%. As for toxicity, the grade 3 or 4 treatment-related adverse event rate was 33% with the combination immunotherapy regimen, 19% with nivolumab alone, and 36% with chemotherapy.

Disclosure: The study authors’ disclosure information can be found at esmo.org.



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