Neoadjuvant Nivolumab Shows Efficacy in Non-small Cell Lung Cancer

Neoadjuvant nivolumab is safe and provides a comparable pathologic response to that with cisplatin-based neoadjuvant chemotherapy in resectable non–small cell lung cancer (NSCLC), according to a study that will be presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.¹

Though nivolumab is approved for the treatment of metastatic NSCLC, the role of PD-1 inhibitors in resectable NSCLC is not known. This is the first study to evaluate nivolumab in the neoadjuvant setting.

The study treated 22 patients with stage IB-IIIA NSCLC with 2 doses of 3 mg/kg of nivolumab over 4 weeks prior to tumor resection. Complete resection was not possible in 1 patient.

There were no surgery delays, and nivolumab was well-tolerated.

Major pathologic response occurred in 43% of patients (95% CI, 24-63%), and 86% were alive and recurrence-free after 9 months of median postoperative follow-up.

Exome sequencing of pretreatment tumors demonstrated an association of pathologic response with tumor mutation and predicted neoantigen loads.

Tumors with a response to nivolumab demonstrated an influx of PD-1+CD8+ T cells, and TCR sequencing showed expanded peripheral T cell clones after treatment.

According to the investigators, the “major pathologic response rate was encouraging and compares favorably to outcomes with cisplatin-based neoadjuvant chemotherapy.”

Reference

1. Chaft JE, Forde PM, Smith KN, et al. Neoadjuvant nivolumab in early-stage, resectable non-small cell lung cancers. J Clin Oncol. 2017;35(suppl; abstr 8508).