Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
Luis G. Paz-Ares , Tudor-Eliade Ciuleanu , Manuel Cobo-Dols , Jaafar Bennouna , Ying Cheng , Hideaki Mizutani , Alejo Lingua , Felipe Reyes , Niels Reinmuth , Juliana Janoski De Menezes , Jacek Jassem , Svetlana Protsenko , Kynan Feeney , Emmanuel De La Mora Jimenez , Shun Lu , Tom John , David Paul Carbone , Xiaoqing Zhang , Nan Hu , Martin Reck
Background: In CheckMate 9LA (NCT03215706), 1L NIVO + IPI combined with 2 cycles of chemo was shown to provide survival benefit vs chemo alone in pts with metastatic NSCLC. Here, we report updated efficacy and safety with a 3-year minimum follow-up, as well as exploratory biomarker analyses from this study. Methods: Adults with stage IV or recurrent NSCLC, no known sensitizing EGFR/ALK alterations, and ECOG performance status ≤ 1 were randomized 1:1 to NIVO 360 mg Q3W + IPI 1 mg/kg Q6W + 2 cycles of chemo (n = 361) or 4 cycles of chemo alone (n = 358). Pts were stratified by tumor PD-L1 expression, sex, and histology. Pts with non-squamous (NSQ) NSCLC in the chemo-alone arm could receive pemetrexed maintenance. Assessments included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). For all pts with NSQ NSCLC and with tissue evaluable for mutational analysis (n = 313), the FoundationOne CDxTM assay was used to identify mutant (mut) or wild type (wt) KRAS and STK11 genes. Exploratory assessments included evaluation of OS and PFS with NIVO + IPI + chemo vs chemo by mutation status and safety. Results: At a minimum follow-up of 36.1 mo (database lock: Feb 15, 2022), pts continued to derive long-term, durable OS benefit with NIVO + IPI + chemo vs chemo (HR, 0.74 [95% CI, 0.62–0.87]); 3-y OS rates were 27% vs 19%. Clinical benefit with NIVO + IPI + chemo vs chemo was observed in all randomized pts and across most subgroups, including by PD-L1 expression level (Table) or histology. In an exploratory analysis in pts evaluable for mutations including KRAS and STK11, OS appeared to be improved with NIVO + IPI + chemo vs chemo (median OS, 16.3 vs 13.1 mo). Similar trends of prolonged OS with NIVO + IPI + chemo vs chemo were also seen in pts with or without KRAS mutation (median OS, mut: 19.2 vs 13.5 mo; wt: 15.6 vs 12.7 mo) or STK11 mutation (mut: 13.8 vs 10.7 mo; wt: 17.8 vs 13.9 mo), respectively. Additional efficacy outcomes will be presented. No new safety signals were identified with extended follow-up. Conclusions: With a 3-year minimum follow-up, 1L NIVO + IPI + chemo demonstrated long-term, durable efficacy benefit vs chemo in pts with metastatic NSCLC. Survival benefit of NIVO + IPI + chemo vs chemo was observed regardless of KRAS and STK11 mutation status. Clinical trial information: NCT03215706.
PD-L1 < 1% | PD-L1 < 1% | PD-L1 ≥ 1% | PD-L1 ≥ 1% | All randomized | All randomized | |
---|---|---|---|---|---|---|
NIVO + IPI + chemo (n = 135) | Chemo (n = 129) | NIVO + IPI + chemo (n = 204) | Chemo (n = 204) | NIVO + IPI + chemo (n = 361) | Chemo (n = 358) | |
Median OS, mo | 17.7 | 9.8 | 15.8 | 10.9 | 15.8 | 11.0 |
OS HR (95% CI) vs chemo | 0.67 (0.51–0.88) | – | 0.74 (0.60–0.93) | – | 0.74 (0.62–0.87) | – |
3-y OS rate, % | 25 | 15 | 28 | 19 | 27 | 19 |
3-y PFS rate, % | 17 | 3 | 12 | 6 | 13 | 5 |
ORR, n (%) | 43 (32) | 26 (20) | 86 (42) | 56 (28) | 137 (38) | 90 (25) |
Median DOR, mo | 17.5 | 4.3 | 11.3 | 5.6 | 12.4 | 5.6 |
Responders with ongoing response ≥ 3 y, % | 37 | 0 | 18 | 17 | 23 | 14 |
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