Nivolumab in the First-Line Treatment of Advanced or Recurrent Lung Cancer
Based on the findings of the phase III CheckMate 026 trial, first-line nivolumab offered no progression-free survival benefit over platinum-based chemotherapy in patients with stage IV or recurrent non–small cell lung cancer (NSCLC) with programmed cell death ligand 1 (PD-L1) expression level ≥ 5%. However, David P. Carbone, MD, PhD, Director, James Thoracic Center, The Ohio State University Comprehensive Cancer Center, and colleagues reported nivolumab had a favorable safety profile compared with chemotherapy, and overall survival was similar between the groups, in an article in The New England Journal of Medicine.
A total of 541 patients with PD-L1 tumor expression ≥ 1% were included in this open-label international trial. Approximately half received nivolumab every 2 weeks, and the other half received investigator’s choice of platinum doublet chemotherapy every 3 weeks for 4 to 6 cycles. Chemotherapy regimens consisted of pemetrexed/carboplatin, pemetrexed/cisplatin, gemcitabine/carboplatin, gemcitabine/cisplatin, and paclitaxel/carboplatin.
Of the 423 patients with PD-L1 expression level ≥ 5%, the median progression-free survival was 4.2 months with nivolumab versus 5.9 months with chemotherapy. The median overall survival was 14.4 months with nivolumab versus 13.2 months with chemotherapy. Treatment-related adverse events of any grade were more common with chemotherapy than with nivolumab (92% vs. 71%), as were treatment-related grade 3 or 4 adverse events (51% vs. 18%).
