Dual Checkpoint Blockade With Some Chemo Boosts OS in NSCLC

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fairly difficult
Nivolumab-ipilimumab with two cycles of chemotherapy improved survival, regardless of histology or PD-L1 status
A first-line immune checkpoint inhibitor combination of nivolumab (Opdivo) plus ipilimumab (Yervoy) improved survival in patients with advanced non-small cell lung cancer (NSCLC) when added to a limited course of chemotherapy, results of the phase III CheckMate-9LA trial showed.

With 8.1 months minimum follow-up, overall survival (OS) reached a median 14.1 months when nivolumab plus ipilimumab was added to two cycles of platinum-based chemotherapy, as compared to 10.7 months with four cycles of chemotherapy plus optional pemetrexed (Alimta) maintenance (HR 0.69, 96.71% CI 0.55-0.87, P=0.0006), reported David Carbone, MD, PhD, of the Ohio State University Comprehensive Cancer Center in Columbus.

And with longer follow-up (12.7 months), median OS reached 15.6 months in the immunotherapy-chemotherapy arm versus 10.9 months in the chemotherapy-alone arm (HR 0.66, 95% CI 0.55-0.80), he said during a presentation at the virtual North America Conference on Lung Cancer.

Landmark analyses showed that 81% of patients treated with the PD-1/CTLA-4 inhibitors plus chemotherapy combination were alive at 6 months compared to 73% with chemotherapy alone. At 12 months, 63% versus 47% remained alive, respectively.

"Importantly, there was early separation of the overall survival curves and lower progressive disease rates as best overall response," said Carbone. "Thus, the basic hypothesis for adding two cycles of chemo was validated."

Asked where nivolumab-ipilimumab plus limited chemotherapy could fit into the current treatment landscape, Carbone pointed out that none of the available first-line immunotherapy options in NSCLC have been compared head to head, but that the findings revealed two things.

"One is that two cycles of chemotherapy may be enough when used with this combination, and that's certainly…
Ian Ingram
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