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David S. Ettinger, MD, FACP, FCCP

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Neoadjuvant Nivolumab Plus Chemotherapy in Advanced Resectable NSCLC

By: Kayci Reyer
Posted: Friday, July 8, 2022

According to the results of the phase II NADIM II trial, presented at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 8501), neoadjuvant treatment of nivolumab plus paclitaxel plus carboplatin resulted in improved clinical outcomes over chemotherapy alone in patients with resectable stage IIIA non–small cell lung cancer (NSCLC). Mariano Provencio-Pulla, MD, PhD, of Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, and colleagues noted the benefits of this therapeutic strategy were seen in terms of pathologic complete response as well as the feasibility of surgery.

“This treatment should become the standard of care in these patients,” concluded the authors.

The study enrolled 87 evaluable patients without EGFR/ALK alterations and with an Eastern Cooperative Oncology Group performance status of 1 or below between February 2019 and November 2021. Prior to surgical treatment, patients were randomly assigned to receive 200 mg/m2 of paclitaxel plus AUC = 5 of carboplatin with or without 360 mg of nivolumab every 21 days for three cycles.

The pathologic complete response rate was significantly higher in the nivolumab group (36.2% vs. 6.8%). The rates of major pathologic and overall response were also higher for those receiving nivolumab (52% vs. 14% and 74% vs. 48%, respectively). In addition, overall, 91% of patients in the nivolumab group and 69% of patients in the chemotherapy-alone group underwent definitive surgery. Reasons for surgery cancellation, although rare, included adverse events and disease progression.

Furthermore, patients in the nivolumab group who experienced a pathologic complete response had a higher median PD-L1 tumor proportion score than those who did not achieve a pathologic complete response (70% vs. 0%). The pathologic complete response was positively associated with PD-L1 tumor proportion scores, according to the authors. The AUC used to anticipate pathologic complete response was 0.734.

Disclosure: For full disclosures of the study authors, visit coi.asco.org.


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