Sensitivity of treatment-free survival (TFS), a novel outcome, to subgroup analyses of patients (pts) with advanced melanoma (MEL) treated with immune checkpoint inhibitors (ICI).

Authors

null

Charlene Mantia

Beth Israel Deaconess Medical Center, Boston, MA

Charlene Mantia , Lillian Werner , Sumati Rao , Corey Ritchings , Ahmad A. Tarhini , Michael B. Atkins , David F. McDermott , Meredith M. Regan

Organizations

Beth Israel Deaconess Medical Center, Boston, MA, Dana-Farber Cancer Institute, Boston, MA, Bristol-Myers Squibb, Princeton, NJ, Emory University and Winship Cancer Institute, Atlanta, GA, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, 1 Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA

Research Funding

Pharmaceutical/Biotech Company
NCI SPORE Grant no: P50 CA101942

Background: Many pts treated with ICIs can discontinue treatment and experience ongoing disease control and toxicity. We previously proposed a novel outcome, TFS, as the time between ICI therapy cessation and subsequent therapy initiation or death, with integrated graphical analysis to better characterize the unique effects of ICIs (ASCO 2018 #9531). In the CheckMate 067 and 069 trials of ipilimumab (IPI) and nivolumab (NIVO) alone or in combination (NIVO+IPI) in pts with MEL, the 36-month restricted mean TFS was 8.7, 4.6 and 11.1 mo, respectively. We explored the sensitivity of TFS to be informative of overall survival (OS) differences through subgroup analysis. Methods: Data from MEL pts in the CheckMate 067 and 069 trials were pooled and analyzed. TFS was defined as the area between the Kaplan-Meier curves for two endpoints, from randomization: (A) time to ICI therapy cessation; and (B) time to subsequent therapy initiation or death. TFS was estimated by restricted mean survival time until 36 mo since randomization. Differences in restricted mean TFS between subgroups of pts (such as PD-L1 status, lactate dehydrogenase [LDH], performance status [PS], gender) were calculated with bootstrapped 95% CIs. OS from randomization was also estimated. Results: Among 407 pts treated with NIVO+IPI, restricted mean TFS ranged from 8-13 mo across subgroups (Table). Subgroup differences in mean TFS were larger for prognostic factors LDH and PS and smaller in non-prognostic PD-L1 status and gender subgroups. Conclusions: Clinically meaningful TFS was seen across all subgroups. TFS was sensitive to prognostic subgroup differences. These results provide further support for TFS as a relevant clinical endpoint. Additional subgroups and comparisons with single agent NIVO and IPI arms will be presented at the meeting.

Restricted mean time (mo)OSSubsequent therapy initiation or death, BICI therapy cessation, ATFS, B-ATFS difference (95% CI)
Overall26211011
LDH normal292411134.7 (2.1, 7.3)
LDH > ULN201688
PS 0272311122.5 (0.4, 4.8)
PS 1-2201889
PD-L1 +272310132.3 (-1.8, 6.4)
PD-L1 -25211011
Male272311121.3 (-1.5, 4.2)
Female2418810

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Citation

J Clin Oncol 37, 2019 (suppl; abstr 9550)

DOI

10.1200/JCO.2019.37.15_suppl.9550

Abstract #

9550

Poster Bd #

121

Abstract Disclosures