Nivolumab Monotherapy and Nivolumab Plus Ipilimumab in Recurrent Small Cell Lung Cancer: Results From the CheckMate 032 Randomized Cohort

Neal E. Ready, Patrick A. Ott, Matthew D. Hellmann, Jon Zugazagoitia, Christine L. Hann, Filippo de Braud, Scott J. Antonia, Paolo A. Ascierto, Victor Moreno, Akin Atmaca, Stefania Salvagni, Matthew Taylor, Asim Amin, D. Ross Camidge, Leora Horn, Emiliano Calvo, Ang Li, Wen Hong Lin, Margaret K. Callahan, David R. Spigel

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Nivolumab monotherapy is approved in the United States for third-line or later metastatic small cell lung cancer based on pooled data from nonrandomized and randomized cohorts of the multicenter, open-label, phase 1/2 trial of nivolumab ± ipilimumab (CheckMate 032; NCT01928394). We report updated results, including long-term overall survival (OS), from the randomized cohort. Methods: Patients with small cell lung cancer and disease progression after one to two prior chemotherapy regimens were randomized 3:2 to nivolumab 3 mg/kg every 2 weeks or nivolumab 1 mg/kg plus ipilimumab 3 mg/kg every 3 weeks for four cycles followed by nivolumab 3 mg/kg every 2 weeks. Patients were stratified by number of prior chemotherapy regimens and treated until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) by blinded independent central review. Results: Overall, 147 patients received nivolumab and 96 nivolumab plus ipilimumab. Minimum follow-up for ORR/progression-free survival/safety was 11.9 months (nivolumab) and 11.2 months (nivolumab plus ipilimumab). ORR increased with nivolumab plus ipilimumab (21.9% versus 11.6% with nivolumab; odds ratio: 2.12; 95% confidence interval: 1.06–4.26; p = 0.03). For long-term OS, minimum follow-up was 29.0 months (nivolumab) versus 28.4 months (nivolumab plus ipilimumab); median (95% confidence interval) OS was 5.7 (3.8–7.6) versus 4.7 months (3.1–8.3). Twenty-four–month OS rates were 17.9% (nivolumab) and 16.9% (nivolumab plus ipilimumab). Grade 3 to 4 treatment-related adverse event rates were 12.9% (nivolumab) versus 37.5% (nivolumab plus ipilimumab), and treatment-related deaths were n =1 versus n = 3, respectively. Conclusions: Whereas ORR (primary endpoint) was higher with nivolumab plus ipilimumab versus nivolumab, OS was similar between groups. In each group, OS remained encouraging with long-term follow-up. Toxicities were more common with combination therapy versus nivolumab monotherapy.

Original languageEnglish (US)
Pages (from-to)426-435
Number of pages10
JournalJournal of Thoracic Oncology
Volume15
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • Immunotherapy
  • Ipilimumab
  • Programmed death-1 inhibitor
  • Small cell lung cancer: Nivolumab

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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