Does continuous nivolumab improve outcomes in advanced non-small cell lung cancer?

This study compared 1-year fixed-duration versus continuous nivolumab (Opdivo) for the treatment of previously treated advanced non-small-cell lung cancer (NSCLC). The authors found that continuing nivolumab beyond a fixed duration of 1-year may improve patient outcomes. 

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Treatment for NSCLC is chemotherapy, radiotherapy, and surgical removal of tumors. Despite this, NSCLC can be difficult to treat especially when it is resistant to treatment. 

Nivolumab is an anti-PD1 antibody (immune proteins) that have been approved to treat NSCLC. PD1 is a protein that is found in high numbers on cancer cells and can stop the immune system from killing cancer cells. Nivolumab turns on the immune system to detect and kill cancer cells. Currently, the effectiveness and safety profile for nivolumab has not been determined for continuous use in the treatment of previously treated advanced NSCLC.

There were 252 patients in this trial with previously treated advanced NSCLC. 127 patients were assigned to the continuous treatment (CT) nivolumab group. The other 125 patients were assigned to a fixed 1-year duration nivolumab group. Patients were followed-up for at least 13.5 months.

The average survival without cancer progression was significantly longer in the CT group (24.7 months) compared to the fixed-duration group (9.4 months). Continuing nivolumab beyond 1 year was associated with a 44% higher chance of not having cancer progression. Patients in the CT group also had a 39% higher chance of a longer overall survival compared to the fixed duration group. 

There were no new side effects recorded in this trial from CT of nivolumab. 

The authors concluded that continuing nivolumab beyond 1 year even in patients who have achieved a response may be beneficial. 

This study was sponsored by Bristol-Myers Squibb Company and Ono Pharmaceutical, the manufacturers of nivolumab.