Nivolumab plus chemotherapy improves survival in Stage III Non-Small-Cell Lung Cancer: NEJM

Spain: A recent study published in The New England Journal of Medicine has revealed that combining Nivolumab and Chemotherapy treatment in patients with Stage III Non–Small-Cell Lung Cancer improves pathological response outcomes and higher survival rates. 

The use of perioperative nivolumab in combination with chemotherapy for patients with resectable stage IIIA or IIIB NSCLC suggested that incorporating neoadjuvant nivolumab into the treatment regimen could be a metamorphic for stage III NSCLC patients, ultimately enhancing their overall outcomes and quality of life.

A population constituting around 20% of all NSCLC cases receive a diagnosis of stage III disease. Lack of consensus prompted Dr Mariano et al. to conduct an open-label phase 2 trial investigating the benefits of perioperative treatment with nivolumab, an immune checkpoint inhibitor, combined with chemotherapy.

In this trial, the patients with resectable stage IIIA or IIIB NSCLC were randomly assigned to one of two groups: an experimental group receiving neoadjuvant nivolumab plus platinum-based chemotherapy, or a control group receiving chemotherapy alone, followed by surgery. The experimental group with R0 resections subsequently received adjuvant treatment with nivolumab for six months.

The key findings are:

• Eighty-six patients participated in the study, 57 in the experimental group and 29 in the control group.
• 37% of patients in the experimental group achieved a complete pathological response, compared to a mere 7% in the control group. Surgical procedures were successfully performed in 93% of patients in the experimental group, while only 69% of patients in the control group underwent surgery.
• Kaplan-Meier estimates of progression-free survival at 24 months demonstrated a substantial advantage for the experimental group, with rates reaching 67.2% compared to 40.9% in the control group (hazard ratio for disease progression, recurrence, or death: 0.47; 95% CI, 0.25 to 0.88). Additionally, the experimental group exhibited a higher estimated overall survival at 24 months (85.0%) than the control group (63.6%).
• The treatment regimen demonstrated a manageable safety profile, with grade 3 or 4 adverse events reported in 19% of experimental and 10% of control patients.

The authors concluded that a significant increase in patients achieving survival rate and complete pathological response could be seen when nivolumab is added to the chemotherapy treatment regimen compared to chemotherapy alone, thus improving the overall outcomes and quality of life.

References:

Provencio M, Nadal E et al. "Perioperative Nivolumab and Chemotherapy in Stage III Non–Small-Cell Lung Cancer". The New England Journal of Medicine. June 28, 2023 DOI: 10.1056/NEJMoa2215530