Can nivolumab plus ipilimumab combined with chemotherapy be used as a first-line treatment for patients with non-small cell lung cancer?

This trial looked at nivolumab (Opdivo) plus ipilimumab (Yervoy) combined with 2 cycles of chemotherapy as treatment for patients with non-small cell lung cancer (NSCLC). The authors found that this combination provided an improved overall survival versus chemotherapy-only regimens.

NSCLC is responsible for 85% of all lung cancer diagnoses worldwide. Treatment is usually a combination of chemotherapy, radiation therapy, and surgery. However, in advanced NSCLC, other therapies may be needed.

Nivolumab and ipilimumab (N+I) are immunotherapy drugs that have been approved to treat NSCLC. They turn on the immune system to detect and kill cancer cells. The combination of N+I has shown improved survival in patients with advanced NSCLC as first-line treatment. However, the effectiveness of a limited course of chemotherapy combined with N+I is still under investigation. 

Overall, 719 patients with advanced NSCLC were included in this trial. 361 patients were randomly assigned to receive N+I and 2 cycles of chemotherapy. The remaining 358 patients received 4 cycles of chemotherapy alone. Patients were followed up for an average of 13.2 months.

Overall survival (OS) of patients was significantly longer in the N+I and chemotherapy group (15.6 months) compared to 10.9 months in the chemotherapy-only group. After 12 months, 63% of patients in the N+I and chemotherapy group were alive compared to 47% of the chemotherapy alone group.

Severe side effects were reported in 47% in the N+I and chemotherapy group and 38% of the chemotherapy alone group. The most common side effects were low white and red blood cell counts, and diarrhea. 

The authors concluded that N+I with 2 cycles of chemotherapy significantly improved survival in patients with advanced NSCLC when compared to patients receiving chemotherapy-only regimens. 

This study was funded by Bristol Myers Squibb, the manufacturers of nivolumab and ipilimumab.