NSCLC Coverage From Every Angle

First-Line Treatment of Nivolumab in Advanced Lung Cancer

The immunotherapy nivolumab did not result in longer progression-free survival than did chemotherapy in the overall population of patients with untreated stage IV or recurrent non–small cell lung cancer (NSCLC), in a phase III clinical trial. However, a subset of patients—those with both high tumor mutational burden and high programmed cell death ligand 1 (PD-L1)–positive status—did experience a benefit from immunotherapy, according to an article published in The New England Journal of Medicine.

“These data show we should evaluate these two factors [tumor mutational burden and PD-L1 status] independently to most accurately define who will benefit from immunotherapy,” stated study lead author David Carbone, MD, PhD, of The Ohio State University Comprehensive Cancer Center, in an interview.

A total of 541 patients with previously untreated or recurrent NSCLC received either nivolumab or platinum-based chemotherapy. Approximately 60% of patients crossed over to the immunotherapy arm because of disease progression.

The response rate for those treated with nivolumab was 26.1%, compared with 33.5% for those treated with chemotherapy. The median duration of response before disease progression was longer with immunotherapy than chemotherapy (12.1 vs 5.7 months). However, the response rate to immunotherapy was 75% in patients with both high tumor mutational burden and high PD-L1–positive status. These same two subgroups had a 25% and 23% response rate, respectively, when treated with chemotherapy.