Nivolumab in previously treated advanced non-small cell lung cancer – what is the long-term outlook for survival?

This study investigated survival rates in advanced non-small cell lung cancer (NSCLC) after nivolumab (Opdivo) treatment. 

They found that nivolumab was associated with longer survival time in patients that responded to treatment. 

Lung cancer (LC) is one of the most common cancers worldwide. Non-small cell lung cancer (NSCLC) is the most common subtype. NSCLC is usually diagnosed at an advanced stage. Chemotherapy (CT) can prolong survival in some cases. In many cases, disease progression will still occur. Immunotherapy (IT) is a new option for advanced cancers.

Nivolumab (NVL) is an IT drug. It targets a receptor protein called PD-1. PD-1 is part of a complex involving another protein PD-L1. PD-L1 is highly expressed in cancer cells. PD-1/PD-L1 interactions allow cancer cells to grow rapidly. NVL can improve survival in NSCLC patients. Less is known about long-term survival rates as NVL was only approved in 2014. It is unclear if NVL is associated with long-term survival compared to CT.

This study included 664 patients with NSCLC from 4 clinical trials. All patients were treated with NVL at some stage. Some patients were first treated with docetaxel (Taxotere; a CT drug). The authors compared long-term survival in NVL-treated and CT-treated patients. Patients were grouped according to PD-L1 expression. 

The average survival time with NVL treatment was 10.3 months. The estimated 4-year overall survival (OS) rate was 14%. This was compared to 5% in patients treated with docetaxel. The 4-year OS was 19% in patients with PD-L1 expression of 1% or more. The 4-year OS was 11% in patients with PD-L1 expression of less than 1%. The estimated 4-year progression-free survival (PFS; survival without the cancer growing or spreading) was 8%.

122 patients responded to NVL treatment. In these patients, the average duration of response was 19.1 months. The average survival after response to treatment was 63.2 months in these patients. The 4-year estimated OS for these patients was 53%.

The authors concluded that NVL was associated with longer survival, particularly in patients that responded to treatment.

This study was funded by Bristol-Myers Squibb, the manufacturer of NVL.