First-line nivolumab (NIVO) plus ipilimumab (IPI) plus two cycles of chemotherapy (chemo) versus chemo alone (4 cycles) in patients with advanced non-small cell lung cancer (NSCLC): Two-year update from CheckMate 9LA.

Authors

Martin Reck

Martin Reck

Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany

Martin Reck , Tudor-Eliade Ciuleanu , Manuel Cobo , Michael Schenker , Bogdan Zurawski , Juliana Janoski de Menezes , Eduardo Richardet , Jaafar Bennouna , Enriqueta Felip , Oscar Juan-Vidal , Aurella Alexandru , Hiroshi Sakai , Arnaud Scherpereel , Shun Lu , Luis G. Paz-Ares , David Paul Carbone , Arteid Memaj , Sathiya Marimuthu , Phuong Tran , Tom John

Organizations

Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany, Institutul oncologic Prof Dr Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania, Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain, SF Nectarie Oncology Center, Craiova, Romania, Ambulatorium Chemioterapii, Bydgoszcz, Poland, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, Instituto Oncológico de Córdoba, Córdoba, Argentina, University Hospital of Nantes and INSERM, CRCINA, Nantes, France, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology, Barcelona, Spain, Hospital Universitario La Fe, Valencia, Spain, Institute of Oncology Prof Dr Alexandru Trestioreanu Bucha, Bucharest, Romania, Saitama Cancer Center, Saitama, Japan, University of Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China, Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Clinical Research Unit, Universidad Complutense & CiberOnc, Madrid, Spain, The Ohio State University Comprehensive Cancer Center, Columbus, OH, Bristol Myers Squibb, Princeton, NJ, Bristol Myers Squibb, Springfield, PA, Austin Hospital, Heidelberg, Australia

Research Funding

Pharmaceutical/Biotech Company
Bristol Myers Squibb

Background: In the randomized phase 3 CheckMate 9LA trial (NCT03215706), first-line NIVO + IPI combined with 2 cycles of chemo significantly improved overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) vs chemo alone (4 cycles). Clinical benefit was observed regardless of programmed death ligand 1 (PD-L1) expression level and histology. Here we report data with 2 years’ minimum follow-up from this study. Methods: Adult patients (pts) with stage IV / recurrent NSCLC, ECOG performance status ≤ 1, and no known sensitizing EGFR/ALK alterations were stratified by PD-L1 (< 1% vs ≥ 1%), sex, and histology (squamous vs non-squamous) and were randomized 1:1 to NIVO 360 mg Q3W + IPI 1 mg/kg Q6W + chemo (2 cycles; n = 361) or chemo alone (4 cycles; n = 358). Pts with non-squamous NSCLC in the chemo-alone arm could receive pemetrexed maintenance. The primary endpoint was OS. Secondary endpoints included PFS and ORR by blinded independent central review, and efficacy by different PD-L1 levels. Safety was exploratory. Results: At a minimum follow-up of 24.4 months for OS (database lock: Feb 18, 2021), pts treated with NIVO + IPI + chemo continued to derive OS benefit vs chemo, with a median OS of 15.8 months vs 11.0 months, respectively (HR, 0.72 [95% CI, 0.61–0.86]); 2-year OS rates were 38% vs 26%. Median PFS with NIVO + IPI + chemo vs chemo was 6.7 months vs 5.3 months (HR, 0.67 [95% CI, 0.56–0.79]); 8% and 37% of pts who had disease progression received subsequent immunotherapy, respectively. ORR was 38% with NIVO + IPI + chemo vs 25% with chemo. Similar clinical benefit with NIVO + IPI + chemo vs chemo was observed in all randomized pts and across the majority of subgroups, including by PD-L1 expression level (Table) or histology. Any grade and grade 3–4 treatment-related adverse events were reported in 92% and 48% of pts in the NIVO + IPI + chemo arm vs 88% and 38% in the chemo arm, respectively. Conclusion: With 2 years’ minimum follow-up, first-line NIVO + IPI + chemo demonstrated durable survival and benefit versus chemo in pts with advanced NSCLC; no new safety signals were identified. Clinical trial information: NCT03215706

Summary of efficacy outcomes by PD-L1 expression.



PD-L1
< 1%

PD-L1
< 1%

PD-L1
≥ 1%

PD-L1
≥ 1%

PD-L1
≥ 50%

PD-L1
≥ 50%

All randomized
All randomized

NIVO + IPI +
chemo
n = 135

Chemo
n = 129

NIVO + IPI +
chemo
n = 204

Chemo
n = 204

NIVO + IPI +
chemo
n = 76

Chemo
n = 98

NIVO + IPI +
chemo
n = 361

Chemo
n = 358

Median OS, months
17.7
9.8
15.8
10.9
18.9
12.9
15.8
11.0
OS HR (95% CI)

vs chemo
0.67

(0.51–0.88)
-
0.70

(0.56–0.89)
-
0.67

(0.46–0.97)
-
0.72

(0.61–0.86)
-
2-year OS rate, %
37
22
41
28
45
32
38
26
2-year PFS rate, %
20
5
20
9
28
10
20
8
ORR, n (%)
42 (31)
26 (20)
87 (43)
57 (28)
38 (50)
31 (32)
137 (38)
91 (25)
Median duration of response, months
17.5
4.3
11.8
5.6
26.0
5.4
13.0
5.6
Responders with ongoing response
≥ 2 years, %
45
0
33
13
52
16
34
12

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Oral Abstract Session

Session Title

Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Clinical Trial Registration Number

NCT03215706

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 9000)

DOI

10.1200/JCO.2021.39.15_suppl.9000

Abstract #

9000

Abstract Disclosures