Combination immunotherapy beats chemotherapy, there is no data to compare against a chemo immunotherapy combination, but is an option for patients who may not tolerate chemotherapy.
We present 5-year results from CheckMate 227 Part 1, in which nivolumab plus ipilimumab improved overall survival (OS) versus chemotherapy in patients with metastatic non–small-cell lung cancer, regardless of tumor programmed death ligand 1 (PD-L1) status.
Adults with stage IV/recurrent non–small-cell lung cancer without EGFR mutations or ALK alterations and with tumor PD-L1 ≥ 1% or < 1% (n = 1739) were randomly assigned. Patients with tumor PD-L1 ≥ 1% were randomly assigned to first-line nivolumab plus ipilimumab, nivolumab alone, or chemotherapy. Patients with tumor PD-L1 < 1% were randomly assigned to nivolumab plus ipilimumab, nivolumab plus chemotherapy, or chemotherapy. End points included exploratory 5-year results for efficacy, safety, and quality of life.
At a minimum follow-up of 61.3 months, 5-year OS rates were 24% versus 14% for nivolumab plus ipilimumab versus chemotherapy (PD-L1 ≥ 1%) and 19% versus 7% (PD-L1 < 1%). The median duration of response was 24.5 versus 6.7 months (PD-L1 ≥ 1%) and 19.4 versus 4.8 months (PD-L1 < 1%). Among patients surviving 5 years, 66% (PD-L1 ≥ 1%) and 64% (PD-L1 < 1%) were off nivolumab plus ipilimumab without initiating subsequent systemic anticancer treatment by the 5-year time point. Survival benefit continued after nivolumab plus ipilimumab discontinuation because of treatment-related adverse events, with a 5-year OS rate of 39% (combined PD-L1 ≥ 1% and < 1% populations). Quality of life in 5-year survivors treated with nivolumab plus ipilimumab was similar to that in the general US population through the 5-year follow-up. No new safety signals were observed.
With all patients off immunotherapy treatment for ≥ 3 years, nivolumab plus ipilimumab increased 5-year survivorship versus chemotherapy, including long-term, durable clinical benefit regardless of tumor PD-L1 expression. These data support nivolumab plus ipilimumab as an effective first-line treatment for patients with metastatic non–small-cell lung cancer.
Another option for combination chemo immunotherapy; we have a clinical trial in FCS now with another combination of chemotherapy + PD-L1 and TIGIT inhibitors, PLEASE CONSIDER IT FOR UNRESECTABLE NSCLC patients.
Another EGFR inhibitor beating chemotherapy in EGFR mutated NSCLC in the adjuvant setting.
Oleclumab (MEDI9447) is a human IgG1λ mAb that inhibits the function of cluster of differentiation 73 (CD73).8 CD73 is an enzyme found on the surfaces of cancer and immune cells and is involved in conversion of adenosine monophosphate to extracellular adenosine, which has an immunosuppressive effect on the tumor environment.9 CD73 upregulation by tumors has been shown to increase extracellular adenosine production and result in subsequent local immunosuppression in multiple canc
New 3rd gen TKI in EGFR+ patients to consider with strong efficacy, only available in China currently. Shows again that ORR is not better with the newer drug, rather its more the duration of response which is far superior.
Another study showing that ctDNA will absolutely change how we manage and follow patients in a myriad of neoplasms, with decreased utilization of CT scans in the next decade.
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