Longer survival without progression in patients with NSCLC with nivolumab plus chemotherapy before surgery

This study investigated the antitumor activity, safety, and survival after nivolumab (Opdivo) and chemotherapy before surgery for patients with stage IIIA non-small-cell lung cancer (NSCLC).

The study showed a high rate of survival without cancer worsening among these patients.

NSCLC amounts to over 80% of all lung cancer diagnoses. Patients with stage III NSCLC have a poor prognosis with standard therapies. Patients with stage III NSCLC can be candidates for surgery to remove the lung tumor. A pathological complete response (pCR) after surgery has been associated with better survival outcomes. A pCR is when there are no cancer cells left in tissues removed during surgery after treatment with drugs or radiotherapy.

Chemotherapy drugs like paclitaxel (Taxol) and carboplatin (Paraplatin) and immunotherapies like nivolumab have been used before surgery to improve pCR in patients with stages I-II NSCLC. However, there is not yet enough data on the antitumor activity, side-effects, and survival with nivolumab and chemotherapy before surgery in patients with stage III NSCLC.

The study enrolled 46 patients with operable, stage IIIA NSCLC. All patients received three 21-day-cycles of chemotherapy with paclitaxel and carboplatin in combination with nivolumab. After the three cycles, the cancer was surgically removed. After surgery, the patients received nivolumab for 1 year. The average follow-up time was 24 months.

At 24 months, 35 out of 41 (85%) patients reached were alive without cancer recurrence. At 2 years, 89.9% of patients were alive. 

93% of the patients showed side-effects during treatment before surgery. 30% of patients had severe side effects. Significant medium to severe side-effects occurred in 30%. None of the patients stopped treatment before surgery due to side effects.

The authors concluded that nivolumab and chemotherapy before surgery improved the outcomes of patients with stage III NSCLC.

The study was supported by the pharmaceutical company Bristol-Myers Squibb, the manufacturer of nivolumab. The number of patients in this study was low. Also, there was no comparison group to a placebo. Further studies are needed.