Five-Year Survival Outcomes with Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small-Cell Lung Cancer in CheckMate 227

Julie R. Brahmer, Jong Seok Lee, Tudor Eliade Ciuleanu, Reyes Bernabe Caro, Makoto Nishio, Laszlo Urban, Clarisse Audigier-Valette, Lorena Lupinacci, Randeep Sangha, Adam Pluzanski, Jacobus Burgers, Mauricio Mahave, Samreen Ahmed, Adam J. Schoenfeld, Luis G. Paz-Ares, Martin Reck, Hossein Borghaei, Kenneth J. O'Byrne, Ravi G. Gupta, Judith BushongLi Li, Steven I. Blum, Laura J. Eccles, Suresh S. Ramalingam

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSEWe present 5-year results from CheckMate 227 Part 1, in which nivolumab plus ipilimumab improved overall survival (OS) versus chemotherapy in patients with metastatic non-small-cell lung cancer, regardless of tumor programmed death ligand 1 (PD-L1) status.METHODSAdults with stage IV/recurrent non-small-cell lung cancer without EGFR mutations or ALK alterations and with tumor PD-L1 ≥ 1% or < 1% (n = 1739) were randomly assigned. Patients with tumor PD-L1 ≥ 1% were randomly assigned to first-line nivolumab plus ipilimumab, nivolumab alone, or chemotherapy. Patients with tumor PD-L1 < 1% were randomly assigned to nivolumab plus ipilimumab, nivolumab plus chemotherapy, or chemotherapy. End points included exploratory 5-year results for efficacy, safety, and quality of life.RESULTSAt a minimum follow-up of 61.3 months, 5-year OS rates were 24% versus 14% for nivolumab plus ipilimumab versus chemotherapy (PD-L1 ≥ 1%) and 19% versus 7% (PD-L1 < 1%). The median duration of response was 24.5 versus 6.7 months (PD-L1 ≥ 1%) and 19.4 versus 4.8 months (PD-L1 < 1%). Among patients surviving 5 years, 66% (PD-L1 ≥ 1%) and 64% (PD-L1 < 1%) were off nivolumab plus ipilimumab without initiating subsequent systemic anticancer treatment by the 5-year time point. Survival benefit continued after nivolumab plus ipilimumab discontinuation because of treatment-related adverse events, with a 5-year OS rate of 39% (combined PD-L1 ≥ 1% and < 1% populations). Quality of life in 5-year survivors treated with nivolumab plus ipilimumab was similar to that in the general US population through the 5-year follow-up. No new safety signals were observed.CONCLUSIONWith all patients off immunotherapy treatment for ≥ 3 years, nivolumab plus ipilimumab increased 5-year survivorship versus chemotherapy, including long-term, durable clinical benefit regardless of tumor PD-L1 expression. These data support nivolumab plus ipilimumab as an effective first-line treatment for patients with metastatic non-small-cell lung cancer.

Original languageEnglish (US)
Pages (from-to)1200-1212
Number of pages13
JournalJournal of Clinical Oncology
Volume41
Issue number6
DOIs
StatePublished - Feb 20 2023

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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