Dr. Roland on the Safety of Neoadjuvant Checkpoint Blockade in Sarcoma

Christina L. Roland, MD, MS, FACS, chief of Sarcoma Surgery and assistant professor in the Department of Surgical Oncology in the Division of Surgery; and associate medical director of the Sarcoma Center at The University of Texas MD Anderson Cancer Center, discusses the safety profile of neoadjuvant checkpoint blockade in patients with undifferentiated pleomorphic sarcoma (UPS) and dedifferentiated liposarcoma (DDLPS).

In the study, investigators examined neoadjuvant nivolumab (Opdivo) monotherapy and the combination of ipilimumab (Yervoy) plus nivolumab with and without radiation in patients with treatment-naïve or locally recurrent DDLPS and UPS.

In general, patients tolerated the regimen relatively well, says Roland. In the DDLPS group that just received nivolumab,essentially no grade 3 toxicities were reported. In all other groups, the most common toxicity reported was colitis, which was not surprising in the groups that received ipilimumab, says Roland. Even in the nivolumab/radiation group, however, it seemed that adding radiation increased toxicity, which was more equivalent to dual checkpoint blockade, explains Roland. Patients in the triplet group experienced the most toxicity.

All patients were able to recover from their toxicity and only 1 surgical delay was reported in the ipilimumab/nivolumab arm because of this, although that patient was later able to undergo surgery. In the 3 arms that did not receive nivolumab, at least 30% of patients were unable to complete the treatment because of toxicity, according to Roland.

Notably, even in patients with UPS who received either nivolumab plus radiation or ipilimumab/nivolumab plus radiation, 40% and 50%, respectively, did not receive all of the therapy but still had a significant response. More correlative analyses need to be done, but it is possible that these patients do not need the 4 total doses and 1 or 2 doses might still be enough to experience a response, concludes Roland.