Martin Reck, MD, PhD, head of the department of thoracic oncology and the Clinical Trial Department within the Department of Thoracic Oncology at Lung Clinic Grosshansdorf, Grosshansdorf, Germany, discusses updated results of the phase 3 CheckMate 9LA study (NCT03215706) in advanced non–small cell lung cancer (NSCLC).

The CheckMate 9LA study evaluated the first-line combination of nivolumab (Opdivo) and ipilimumab (Yervoy) plus 2 cycles of chemotherapy compared with chemotherapy alone in patients with advanced NSCLC. An interim analysis of the study demonstrated improved overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) with the chemoimmunotherapy regimen compared with up to 4 cycles of chemotherapy alone. 

During the 2021 ASCO Annual Meeting, updated findings from CheckMate 9LA were presented virtually and demonstrated continued benefit with the chemoimmunotherapy regimen vs chemotherapy alone in this patient population, says Reck. At a minimum follow-up of 2 years, the median OS was 15.8 months with nivolumab/ipilimumab plus 2 cycles of chemotherapy vs 11.0 months with chemotherapy alone. The 2-year OS rates were 38% vs 26%, respectively. Additionally, PFS and ORR were improved with the combination approach vs chemotherapy alone at 2 years, concludes Reck.

Videos

Martin Reck, MD, PhD, discusses updated results of the phase 3 CheckMate 9LA study in advanced non–small cell lung cancer. 



Dr. Reck on Updated Results of the CheckMate 9LA Trial in Advanced NSCLC 

Martin Reck, MD, PhD, head of the department of thoracic oncology and the Clinical Trial Department within the Department of Thoracic Oncology at Lung Clinic Grosshansdorf, discusses the efficacy of maintenance atezolizumab (Tecentriq) in patients with extensive-stage small cell lung cancer (ES-SCLC).

The majority of patients enrolled on the phase 3 IMpower133 trial had previously received 4 cycles of chemotherapy, according to Reck. Investigators reported that several prognostic factors were associated with unfavorable outcomes for those receiving maintenance therapy, including older age, low performance status, and high antidiuretic hormone levels. 

Efficacy data on maintenance atezolizumab appeared to demonstrate a continuation of the survival benefit observed from the primary chemoimmunotherapy regimen patients were administered, says Reck. When looking at overall survival (OS) from the start of maintenance therapy, results showed that maintenance atezolizumab demonstrated a higher median OS of 12.5 versus  those who were given a placebo; this corresponds with a hazard ratio of 0.59.

Moreover, when examining OS starting from randomization, a median OS of 11.3 was reported in the control arm versus 15.7 months in the investigational arm, adds Reck. Results also indicated a confirmatory benefit with regard to progression-free survival that favored maintenance atezolizumab, Reck concludes.

Martin Reck, MD, PhD, discusses the efficacy of maintenance atezolizumab in patients with extensive-stage small cell lung cancer.

Dr. Reck on the Efficacy of Maintenance Atezolizumab in ES-SCLC

Martin Reck, MD, PhD, head of the department of thoracic oncology and head of the Clinical Trial Department within the Department of Thoracic Oncology at Lung Clinic Grosshansdorf, discusses the safety profile observed with of pembrolizumab (Keytruda) versus chemotherapy in patients with metastatic non–small cell lung cancer in the phase 3 KEYNOTE-024 trial.

Tolerability was in favor of first-line pembrolizumab (Keytruda), says Reck. The majority of immune-mediated adverse effects (imAEs) that were reported were mild to moderate, with very few patients experiencing significant or clinically relevant toxicities. The majority of these effects could be successfully controlled in most patients with the use of immune suppressive drugs, such as corticosteroids, adds Reck.

When looking at the subgroup of patients who received 2 years of pembrolizumab, no change in tolerability was observed, adds Reck. Moreover, 31.2% of patients experienced a grade 3 to 5 imAE, which was consistent with had had been reported in the initial analysis of the trial, concludes Reck.

Martin Reck, MD, PhD, discusses the safety profile observed with of pembrolizumab versus chemotherapy in patients with metastatic non–small cell lung cancer in the phase 3 KEYNOTE-024 trial.

Dr. Reck on the Safety of Pembrolizumab in KEYNOTE-024 in Metastatic NSCLC

Martin Reck, MD, PhD, head of the department of thoracic oncology at Lung Clinic Grosshansdorf, discusses ​safety data from the ​phase 3 

 in metastatic or recurrent non–small cell lung cancer (NSCLC).

Findings from the study suggest that the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) plus 2 cycles of platinum-doublet chemotherapy ​should be considered an option for this patient population.

However, it is an intensive regimen, says Reck. Moreover, treatment-emergent adverse effects (AEs) were observed more frequently with the experimental regimen compared with chemotherapy alone.

Treatment-related deaths occurred in 2% of patients in both arms.

Notably, the incidence of chemotherapy-related AEs including hematologic AEs was lower in the combination arm ​as patients received 2 ​cycles ​of chemotherapy versus 4, Reck concludes.

Martin Reck, MD, PhD, discusses ​safety data from the ​phase 3 CheckMate-9LA trial in metastatic or recurrent non–small cell lung cancer.

Dr. Reck on Safety Data From the CheckMate-9LA Trial in Metastatic/Recurrent NSCLC

Martin Reck, MD, Department of Thoracic Oncology, Lung Clinic Grosshansdorf, discusses the IMpower150 trial data for patients with non—small cell lung cancer (NSCLC).

The IMpower150 trial was the first investigation on the combination of chemotherapy, antiangiogenic treatment, and immunotherapy, says Reck in an interview during the 2018 European Lung Cancer Congress, which is a joint collaboration between ESMO and the IASLC. There is good evidence to suggest that there is a synergistic mechanism between antiangiogenic treatment, chemotherapy, and immunotherapy.

Previous data demonstrated that the combination of atezolizumab (Tecentriq), bevacizumab (Avastin), carboplatin, and paclitaxel delayed progression or death by 38% compared with bevacizumab and chemotherapy alone for patients with nonsquamous NSCLC.

This is a very intensive treatment, Reck explains. Patients are receiving chemotherapy, bevacizumab, and immunotherapy, so one needs to be aware of the adverse events associated with this combination. Therefore, patients must be selected carefully for this treatment but overall the tolerability was as expected, explains Reck.

Martin Reck, MD, Department of Thoracic Oncology, Lung Clinic Grosshansdorf, discusses the IMpower150 trial data for patients with non

Dr. Reck on the Rationale of the IMpower150 Trial in NSCLC

Martin Reck, MD, Department of Thoracic Oncology, Lung Clinic Grosshansdorf, discuses the REVEL trial, a randomized phase III study of docetaxel with ramucirumab or placebo for second-line treatment of stage IV non-small-cell lung cancer (NSCLC).

A significant improvement in overall survival in favor of the combination of docetaxel with ramucirumab, says Reck. An improvement in progression-free survival (PFS) and response rate was also observed.

This important in efficacy was seen independent from histology. An additional analysis was performed on patients who were chemotherapy refractory patients. An additional benefit was seen in this poor prognostic group, said Reck.

Martin Reck, MD

Articles

Dr. Reck on Updated Results of the CheckMate 9LA Trial in Advanced NSCLC

Dr. Reck on the Efficacy of Maintenance Atezolizumab in ES-SCLC

Dr. Reck on the Safety of Pembrolizumab in KEYNOTE-024 in Metastatic NSCLC

Dr. Reck on Safety Data From the CheckMate-9LA Trial in Metastatic/Recurrent NSCLC

Dr. Reck on the Rationale of the IMpower150 Trial in NSCLC

Dr. Martin Reck on Docetaxel/Ramucirumab in NSCLC