Should ipilimumab and nivolumab treatment be considered before surgery in operable non-small cell lung cancer?

This trial was carried out to look at the effectiveness of nivolumab (Opdivo) and nivolumab plus ipilimumab (Yervoy) as neoadjuvant therapy (NAT; treatment before surgery) in treating operable non-small cell lung cancer (NSCLC). The authors found that ipilimumab and nivolumab treatment before surgery provides better outcomes for these patients.

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. 

NAT is the use of a therapy before surgery to reduce the size of a tumor or spread around the body. It can make the tumor easier to remove completely. Chemotherapy is commonly used as NAT. 

Immunotherapies such as nivolumab and ipilimumab have become important therapies for the treatment of advanced NSCLC. However, the effects of these treatments before surgery in patients with operable NSCLC are not known.

This trial included 44 patients with NSCLC who were preparing to have surgery to remove the tumors. 23 patients received nivolumab alone. 21 patients received nivolumab plus ipilimumab. 39 of these patients underwent surgery to remove tumors. The average length of follow-up was 22.2 months. The main outcomes measured were major pathological response (MPR; less than 10% tumor remaining after NAT) and tumor response rate. 

38% of patients receiving nivolumab and ipilimumab and 22% of the nivolumab alone group achieved an MPR. Tumor pieces removed from patients who received nivolumab and ipilimumab had significantly fewer alive tumor cells compared to those from patients who received nivolumab alone.

In patients who underwent surgical removal of their tumors, MPR was 24% in the nivolumab alone group and 50% in the nivolumab plus ipilimumab group. There was a higher complete tumor response rate in the nivolumab plus ipilimumab group (38%) versus the nivolumab alone group (10%). 

The authors concluded that there was a better tumor response in patients taking both nivolumab and ipilimumab as NAT before surgery to remove tumors in patients with operabel NSCLC.

This study included a very small number of participants. Also, it did not compare the outcomes with other NAT such as chemotherapy or placebo. This trial was sponsored by Bristol Meyers Squibb, the manufacturers of both ipilimumab and nivolumab.