Perioperative nivolumab may bolster survival over only neoadjuvant nivolumab plus chemotherapy for resectable NSCLC
In the fight against non-small cell lung cancer (NSCLC), recent findings from the CheckMate clinical trials have brought hope for better patient outcomes. These trials, which investigated the use of nivolumab in combination with chemotherapy and surgery, have shown that adding adjuvant nivolumab after neoadjuvant therapy can significantly reduce the risk of disease recurrence or death in patients with resectable NSCLC.
This landmark data, presented at the 2024 World Conference on Lung Cancer, comes from an analysis of individual patient data from two major phase 3 trials: CheckMate 77T and CheckMate 816. These studies are among the first to explore the benefits of using nivolumab both before and after surgery in patients with early to mid-stage NSCLC.
Dr. Patrick Forde of The Sidney Kimmel Comprehensive Cancer Center led the CheckMate 816 trial, which demonstrated that neoadjuvant (pre-surgery) nivolumab combined with chemotherapy significantly improved event-free survival (EFS) and pathological complete response rates. Building on this success, Dr. Tina Cascone and her colleagues at MD Anderson Cancer Center conducted the CheckMate 77T trial, which added adjuvant (post-surgery) nivolumab to further reduce the risk of recurrence.
The data from these trials suggest that patients who receive both neoadjuvant and adjuvant nivolumab experience better long-term outcomes than those who receive only neoadjuvant therapy. Specifically, the analysis showed that perioperative nivolumab improved EFS compared to neoadjuvant therapy alone, with a hazard ratio of 0.61, indicating a 39% reduction in the risk of disease recurrence or death.
Importantly, the benefit of perioperative nivolumab was observed in patients regardless of whether they achieved a pathological complete response (pCR) after neoadjuvant therapy. However, the improvement in EFS was more pronounced in patients who did not achieve pCR, suggesting that the addition of adjuvant nivolumab can be particularly beneficial for these individuals.