Dr Myall on Immunotherapy Doublets and Chemoimmunotherapy in NSCLC

Nathaniel Myall, MD, clinical assistant professor, medicine - oncology, Stanford Medicine, discusses efficacy findings from 3 clinical trials investigating combination immunotherapy and chemoimmunotherapy treatment approaches in patients with non–small cell lung cancer (NSCLC).

Several trials evaluating the efficacy of immunotherapy in lung cancer compare dual checkpoint inhibition vs chemotherapy alone, Myall says. Some trials also compare chemoimmunotherapy vs chemotherapy alone in patients with lung cancer, Myall notes. For instance, the phase 3 CheckMate 227 trial (NCT02477826) compared dual checkpoint inhibition with nivolumab (Opdivo) plus ipilimumab (Yervoy) vs chemotherapy in previously untreated patients with metastatic NSCLC regardless of PD-L1 score. The 5-year overall survival (OS) analysis of this trial showed 5-year OS rates of 24% and 14% in the dual checkpoint inhibition and chemotherapy arms, respectively, in patients with PD-L1 expression of at least 1% and 19% and 7%, respectively, in those with PD-L1 expression of less than 1%.

The phase 3 CheckMate 9LA trial (NCT03215706) investigated ipilimumab plus nivolumab and 2 cycles of chemotherapy vs 4 cycles of chemotherapy alone in patients with treatment-naïve metastatic NSCLC. At a minimum follow-up of 47.9 months, 21% of patients in the chemoimmunotherapy arm were alive compared with 16% of those in the chemotherapy alone arm (HR, 0.74; 95% CI, 0.63-0.87). Among patients with PD-L1 expression of less than 1%, the 4-year OS rates were 23% and 13% in the chemoimmunotherapy and chemotherapy alone arms, respectively (HR, 0.66; 95% CI, 0.50-0.86).

The phase 3 POSEIDON trial (NCT03164616) investigated durvalumab (Imfinzi) plus tremelimumab (Imjudo) and platinum-based chemotherapy vs durvalumab plus chemotherapy vs chemotherapy alone in the frontline setting in patients with metastatic NSCLC. The durvalumab/tremelimumab/chemotherapy combination significantly improved both progression-free survival (PFS) and OS vs chemotherapy alone. The median PFS was 6.2 months in the triplet arm vs 4.8 months in the chemotherapy alone arm (HR, 0.72; 95% CI, 0.60-0.86; P = .0003). The median OS was 14.0 months with the triplet vs 11.7 months with chemotherapy alone (HR, 0.77; 95% CI, 0.65-0.92; P = .0030). Additionally, the durvalumab/chemotherapy combination significantly improved median PFS vs chemotherapy alone, at 5.5 months vs 4.8 months, respectively (HR, 0.74; 95% CI, 0.62-0.89; P = .0009).