A pooled analysis of 4 CheckMate trials showed that nivolumab may have a long-term survival benefit in patients with previously treated advanced non-small cell lung cancer (NSCLC), with an estimated 4-year survival of 14% overall.1

Among patients with a PD-L1 expression of at least 1%, the 4-year survival improved to 19%, and among those with PD-L1 expression of less than 1%, 4-year survival was 11%.

“Notably, the most recent estimate of the proportion of patients alive at 5 years since diagnosis for metastatic lung cancer in the USA is 5% for 2008–15, which largely preceded the availability of immunotherapy for lung cancer,” the researchers wrote. “Our results suggest that subsequent updates of overall survival statistics might show substantial improvements in the long-term survival of patients with this disease.”

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The analysis included data from CheckMate trials 017, 057, 063, and 003. These included 2 randomized studies comparing nivolumab and docetaxel (017 and 057). In CheckMate 017 and 057, the 4-year overall survival was 14% in patients assigned nivolumab compared with 5% for those assigned to receive docetaxel.

The researchers also conducted a landmark analysis looking at survival subsequent to response at 6 months on nivolumab or docetaxel. Survival after response at 6 months was longer than after progressive disease at 6 months for both nivolumab (hazard ratio [HR] for overall survival, 0.18; 95% confidence interval [CI], 0.12-0.27) and docetaxel (HR, 0.43; 95% CI, 0.29-0.65).

“A survival benefit of response was maintained even after loss of response,” the researchers noted. “In nivolumab-treated patients with disease progression, those who had a previous complete or partial response had the longest overall survival post-progression. A smaller post-progression survival benefit was noted in patients with disease progression after initial achievement of stable disease.”

In an editorial that accompanied the study,2 Pierre-Jean Souquet, of Institut de Cancérologie des Hospices Civils de Lyon, France, and Sébastien Couraud, Université Lyon, Lyon, France, wrote that the findings, which show about a 3-times higher rate of survival at 5 years, “are a true game changer for patients diagnosed with metastatic NSCLC.”

“Now that a combination of chemotherapy and immunotherapy is becoming the standard first-line treatment for all histologies and for all PD-L1 statuses, it is reasonable to expect greatly improved outcomes with an increasing proportion of patients alive 5 years after diagnosis,” they wrote. “The horizon might still be far, but it appears that the tide has turned.”

Disclosure: The study was funded by Bristol-Myers Squibb. For a full list of disclosures, please refer to the original study.

References

  1. Antonia SJ, Borghai H, Ramalingam SS, et al. Four-year survival with nivolumab in patients with previously treated advanced non-small-cell lung cancer: a pooled analysis [published online August 14, 2019]. Lancet Oncol. doi: 10.1016/S1470-2045(19)30407-3
  2. Souquet P-J, Couraud S. Immune checkpoint inhibitors: a game changer for metastatic non-small-cell lung cancer [published online August 14, 2019]. Lancet Oncol. doi: 10.1016/S1470-2045(19)30508-X