Management of gastrointestinal (GI) toxicity associated with nivolumab (NIVO) plus ipilimumab (IPI) or IPI alone in phase II and III trials in advanced melanoma (MEL).

Authors

null

Jeffrey S. Weber

Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY

Jeffrey S. Weber , James M. G. Larkin , Dirk Schadendorf , Jedd D. Wolchok , John Wagstaff , Reinhard Dummer , David Hogg , Massimo Guidoboni , Jeffrey Alan Sosman , Bartosz Chmielowski , Winald Gerritsen , Rafia Bhore , Dana Walker , Rene Gonzalez

Organizations

Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, Royal Marsden Hospital, London, United Kingdom, University Hospital Essen, Essen, Germany, Memorial Sloan Kettering Cancer Center, New York, NY, Singleton Hospital, South West Wales Cancer Institute and Swansea University College of Medicine, Swansea, United Kingdom, Universitat Zurich, Dermatologische Klinik, Zürich, Switzerland, Princess Margaret Hospital, Toronto, ON, Canada, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy, Northwestern University Medical Center, Chicago, IL, University of California Los Angeles, Hematology-Oncology Outpatient Clinic, Los Angeles, CA, Radboud University Medical Center, Nijmegen, Netherlands, Bristol-Myers Squibb, Princeton, NJ, University of Colorado Comprehensive Cancer Center, Denver, CO

Research Funding

Pharmaceutical/Biotech Company

Background: NIVO and IPI are approved as monotherapy and in combination for treatment of MEL. These treatments are associated with select (potentially immune-related) adverse events (AEs) of the GI tract, most commonly diarrhea and colitis. We describe the management of GI toxicity in patients (pts) treated with NIVO+IPI or IPI from phase II (CheckMate 069) and III (CheckMate 067) trials. Methods: Pts received NIVO 1 mg/kg + IPI 3 mg/kg Q3W x 4, followed by NIVO 3 mg/kg Q2W until progression or unacceptable toxicity, or IPI 3 mg/kg Q3W x 4, followed by placebo. Minimum follow-up was 2 yrs for CheckMate 069 and 18 months for CheckMate 067. Results: Of 407 pts treated with NIVO+IPI, 195 (48%) experienced any grade select GI AEs, and of 357 pts treated with IPI, 132 (37%) experienced any grade select GI AEs. Grade 3/4 select GI AEs were reported in 67 (16%) pts treated with NIVO+IPI and in 41 (11%) pts treated with IPI; median time to onset was 7.1 weeks (range 0.9-48.9) with NIVO+IPI and 7.3 weeks (range 0.6-14.9) with IPI. To manage these AEs, immune-modulating medications (IMM) were used in 61/67 (91%) pts in the NIVO+IPI group and in 41/41 (100%) in the IPI group. Corticosteroids (CS) were used in 61/67 (91%) and 41/41 (100%) pts, and infliximab (IFX) was used in 21/67 (31%) and 14/41 (34%) pts in the NIVO+IPI and IPI groups, respectively. In the NIVO+IPI group, the resolution rate of grade 3/4 select GI AEs was 96%, 97%, and 95% with a median time to resolution of 3.3, 3.0, and 3.9 weeks in all treated pts, CS, and CS+IFX managed pts, respectively; 88%, 92%, and 79% resolved with a median time to resolution of 3.9, 2.4, and 7.8 weeks in the IPI group, respectively. Objective response rates (ORR) were unchanged in the presence of any grade select GI AEs, or by using CS or CS+IFX (Table). Conclusions: NIVO+IPI or IPI alone is associated with a high incidence of GI select AEs, but most are effectively managed by IMMs, which do not appear to inhibit tumor response. Clinical trial information: NCT01844505; NCT01927419

All treated pts
Any grade select GI AEs
All
High-dose CS
CS+IFX
NIVO+IPI
N=407
IPI
N=357
NIVO+IPI N=195IPI N=132NIVO+IPI n=72IPI
n=44
NIVO+IPI n=22IPI n=16
ORR (%)5818631963255525
95% CI53, 6314, 2356, 7013, 2750, 7413, 4032, 767, 52

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Clinical Trial Registration Number

NCT01844505; NCT01927419

Citation

J Clin Oncol 35, 2017 (suppl; abstr 9523)

DOI

10.1200/JCO.2017.35.15_suppl.9523

Abstract #

9523

Poster Bd #

131

Abstract Disclosures

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