Evaluating the safety and effectiveness of nivolumab with carboplatin, paclitaxel, and bevacizumab for first-line treatment of advanced non-squamous non-small cell lung cancer.

This study investigated the effectiveness and safety outcomes of nivolumab (Opdivo) in combination with carboplatin (C; Paraplatin) and paclitaxel (P; Taxol) plus bevacizumab (B; Avastin) as first-line treatment for patients with advanced non-squamous non-small cell lung cancer (NSCLC). The data showed that nivolumab plus BCP combination as first-line treatment significantly increased the survival without cancer worsening with manageable side effects in these patients.

NSCLC is the most common form of lung cancer. It is responsible for around 85% of all lung cancer cases worldwide. Non-squamous is a type of NSCLC. Despite current treatment options improving survival rates, advanced NSCLC can be difficult to treat.

Standard chemotherapy regimens usually contain drugs such as carboplatin, which belong to the class of drugs called platinum analogs. These drugs inhibit the formation of new cells, thus delaying tumor growth and spread. Bevacizumab is a biological (or targeted) drug that works by blocking the production of new blood vessels needed for tumor growth.

Immunotherapy has been found to be effective in advanced NSCLC. Nivolumab is an immunotherapy. It targets a protein PD-1 that plays a major role in the growth of cancerous cells. Blocking PD-1 restores the capacity of the immune system to attack and kill cancer cells. Atezolizumab (A; Tecentriq), another immunotherapy dryg, in combination with bevacizumab, carboplatin, and paclitaxel (A+BCP) has previously shown benefits as first-line treatment for patients with non-squamous NSCLC. However, the effectiveness and safety outcomes of combining nivolumab with BCP as first-line treatment for advanced non-squamous NSCLC are still unknown.

This study involved 548 patients with non-squamous NSCLC. Patients were randomly assigned into 2 groups. Group 1 included 273 patients who received nivolumab plus BCP combination. Group 2 included 275 patients who received a placebo plus BCP combination. The average follow-up time was 13.7 months.

The average survival without cancer worsening was 12.1 months in group 1 compared to 8.1 months in group 2. Nivolumab plus BCP combination reduced the risk of cancer progression by 44% compared to placebo plus BCP combination. After 1 year, 50.1% of patients in group 1 were alive without cancer worsening compared to 30.2% of patients in group 2.

The overall response rate (ORR; partial or complete disappearance of cancer) was 61.5% in group 1 compared to 50.5% in group 2.

Treatment-related side effects were similar between the 2 groups. The most common side effects were low white blood cell counts with and without fever and high blood pressure.

This study concluded that nivolumab with BCP combination as first-line treatment significantly increased the survival without cancer worsening with manageable side effects in patients with advanced non-squamous NSCLC.

All patients selected were from East Asia. The follow-up period was short. A longer follow-up is necessary to evaluate the benefit of nivolumab on overall survival. This study received support from Bristol-Myers Squibb, the manufacturer of nivolumab.