University of California, San Diego, La Jolla, CA
Lyudmila Bazhenova , Mary Weber Redman , Scott N. Gettinger , Fred R. Hirsch , Philip C. Mack , Lawrence Howard Schwartz , David R. Gandara , Jeffrey D. Bradley , Tom Stinchcombe , Natasha B. Leighl , Suresh S. Ramalingam , Susan S Tavernier , Katherine Minichiello , Karen Kelly , Vassiliki Papadimitrakopoulou , Roy S. Herbst
Background: Lung-MAP is a master protocol for patients (pts) with stage IV previously treated SqNSCLC. S1400I enrolled pts who were not eligible for a biomarker-matched sub-study. Methods: S1400I is phase III randomized trial for immunotherapy-naïve patients with ECOG 0-1 not selected by PD-L1 expression. Pts were assigned 1:1 to nivolumab and ipilimumab (N+I) vs nivolumab (N). N was given at 3 mg/kg q 2w, I was given at 1 mg/kg q 6w. The primary endpoint was overall survival (OS). Secondary endpoints: investigator-assessed progression-free survival (IA-PFS), response by RECIST 1.1, and toxicity. Results: From December 18, 2015 to April 23, 2018, 275 pts enrolled and 252 determined eligible (125 N+I and 127 N). The study was closed for futility at an interim analysis. Baseline characteristics were similar across arms. mOS was 10.0 m (8.0-12.8) and 11.0 m (8.2-13.5) for N+I and N. HR 0.97 (0.71-1.31), p 0.82. mPFS was 3.8 m (2.3-4.2) and 2.9 m (1.8-3.9) for N+I and N. HR 0.84 (0.64-1.09), p 0.19. Outcomes based on PD-L1 and TBM subsets are shown in table. Response rates were 18% (12-25%) and 17% (11-24%) for N+ I and N. Median follow up for patients still alive was 17.4 m. Grade ≥3 treatment-related AEs occurred in 48(39%) of pts on N+I vs 38(31%) on N. irAE reported in 39% of pts on N+I and 34% of patients on N. Drug-related AEs led to discontinuation in 25% and 16% of pts on N+I and N. There were 5 grade 5 AE in N+I arm and 1 in N arm. Conclusions: S1400I failed to show improvement in outcomes with N+I. Study was closed for futility at interim analysis. Toxicities were not different between two arms. Clinical trial information: 02785952.
N+I Median in months | N Median in months | HR | p | |
---|---|---|---|---|
OS PD-L1 ≥5 | 14.1 (5.8-17.5) | 12.0 (8.2-19.8) | 1.06 (0.58-1.92) | 0.86 |
OS PD-L1 < 5 | 8.3 (6.0-10.7) | 10.3 (6.3-13.5) | 1.01 (0.62-1.65) | 0.97 |
OS TMB ≥10 | 13.1 (9.3-17.0) | 11.4 (8.2-16.1) | 0.86 (0.56-1.32) | 0.48 |
OS TMB < 10 | 7.6 (5.7-10.2) | 10.0 (6.3-15.2) | 1.08 (0.68-1.71) | 0.74 |
PFS PD-L1 ≥ 5 | 3.9 (1.7-7.1) | 2.9 (1.8-4.7) | 0.65 (0.38-1.08) | 0.10 |
PFS PD-L1 < 5 | 4.4 (2.1-6.0) | 1.6 (1.5-3.0) | 0.64 (0.41-1.01) | 0.06 |
PFS TMB ≥ 10 | 4.2 (3.4-5.9) | 3.4 (1.8-5.3) | 0.75 (0.52-1.10) | 0.15 |
PFS TMB < 10 | 1.9 (1.5-4.1) | 2.7 (1.6-3.3) | 0.92 (0.62-1.39) | 0.70 |
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