Dr. Lenz Discusses Frontline Nivolumab Plus Ipilimumab in mCRC

Heinz-Josef Lenz, MD, associate director for Adult Oncology and co-leader of the Gastrointestinal Cancers Program, USC Norris Comprehensive Cancer Center, discusses the frontline combination of nivolumab (Opdivo) plus ipilimumab (Yervoy) in metastatic colorectal cancer (mCRC).

In a phase II study, nivolumab combined with low-dose ipilimumab is being evaluated as a frontline regimen for patients with microsatellite instability—high (MSI–H), mismatch repair deficient mCRC. At the 2018 ESMO Congress, initial data with this combination were presented, showing that the overall response rate (ORR) was over 55% and that median progression-free survival (PFS), overall survival (OS) and duration of response were not reached. Updated data were presented at the 2019 ASCO Annual Meeting.

At a median follow-up of 20 months, ORR increased to 58%, and median PFS and OS were still not reached, indicating that this a highly effective frontline therapy, Lenz says. In the future, the question will arise if patients with MSI-H mCRC need to receive frontline chemotherapy or whether they can start on this immunotherapy combination. Notably, this is only a single-arm study with a small group of patients, so a larger phase III study is likely necessary to receive regulatory approval, Lenz concludes.