Neoadjuvant immunotherapy shows promise for resectable NSCLC
medwireNews: Neoadjuvant immunotherapy produces encouraging major pathologic response (MPR) rates among patients with resectable non-small-cell lung cancer (NSCLC), show data presented at the 2019 ASCO Annual Meeting in Chicago, Illinois, USA.
David Kwiatkowski, from the Brigham and Women’s Hospital in Boston, Massachusetts, USA, reported interim findings from the phase II LCMC3 trial in which, to date, 77 patients with EGFR and ALK mutation-negative resectable NSCLC (stage IB–IIIB) have been treated with two cycles of atezolizumab 1200 mg (days 1, 22).
Meanwhile, Tina Cascone, from The University of Texas MD Anderson Cancer Center in Houston, USA, presented clinical findings from the phase II NEOSTAR study that looked at the use of nivolumab 3 mg/kg alone on days 1, 15, and 29 (n=23) or in combination with intravenous ipilimumab 1 mg/kg on day 1 (n=21) in patients with stage I–IIIA resectable NSCLC.
In LCMC3, the MPR rate, defined as having 10% or fewer viable tumor cells in the resection specimen, was 19% with atezolizumab, of which 5% were a pathologic complete response (pCR).
The MPR rates in NEOSTAR were 17% in the nivolumab only group and 33% in the nivolumab plus ipilimumab group, with pCR rates of 9% and 29%, respectively. The RECIST objective response rate was 22% and 19%, respectively, with all responses partial except for one patient given the combination regimen who had a complete response.
In both studies, the response rates were higher among patients with elevated PD-L1 expression.
In LCMC3, the rate of grade 3–5 treatment-related adverse events (TRAEs) was 6% with atezolizumab, with no new safety signals detected.
Kwiatkowski thus concluded that “[atezolizumab] in the neoadjuvant setting was well tolerated, and pCR and MPR rates are encouraging in this large multicenter trial.”
He added: “Efficacy interim analysis passed its futility boundary, and study enrollment continues.”
Cascone also reported no unacceptable toxicity, or increased perioperative morbidity or mortality among the patients who received nivolumab with or without ipilimumab. Four patients (17%) in the nivolumab and two (10%) in the nivolumab plus ipilimumab groups experienced a grade 3–5 TRAE.
By Laura Cowen
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