Dual immunotherapy plus chemotherapy before surgery improves patient outcomes in operable lung cancer (Ipilimumab & nivolumab)

Medical Xpress / University of Texas M. D. Anderson Cancer Center / Nature Medicine ^ | March 16, 2023 | Tina Cascone et al

[ConservativeMind]

In a Phase II trial, adding ipilimumab to a pre-surgical combination of nivolumab plus platinum-based chemotherapy, resulted in a major pathologic response (MPR) in half of all treated patients with early-stage, resectable non-small cell lung cancer (NSCLC).

New findings from the NEOSTAR trial provide further support for neoadjuvant immunotherapy-based treatment as an approach to reduce viable tumor at surgery and to improve outcomes in NSCLC. The combination also was associated with an increase in immune cell infiltration and a favorable gut microbiome composition.

The current study reports on the latest two arms of the NEOSTAR trial, evaluating neoadjuvant nivolumab plus chemotherapy (double combination) and neoadjuvant ipilimumab plus nivolumab and chemotherapy (triple combination). Both treatment arms met their prespecified primary endpoint boundaries of six or more patients achieving MPR, defined as 10% or less residual viable tumor (RVT) in the resected tumor specimen at surgery.

In the intention-to-treat population, the triple combination resulted in an MPR rate of 50%, whereas 32.1% of patients achieved MPR after double combination treatment.

Among patients diagnosed with NSCLC, roughly 30% have potentially resectable disease, meaning their tumor can be surgically removed.

The NEOSTAR trial showed that adding a single dose of ipilimumab resulted in an increase in beneficial tumor immune cell infiltration and reduced RVT at surgery.

Patients treated with the triple combination had a median of 4.5% RVT at surgery, compared to 50.5% RVT in patients treated with the double combination. All patients achieving MPR in the triple combination cohort and 86% of those achieving MPR in the double combination cohort had less than 5% RVT at surgery. All patients treated with the double combination and 91% of those treated with the triple combination underwent surgery. No new safety signals were observed in both treatment arms.

[ConservativeMind]

It seems 9% of the triple pre-treated people did not require surgery, at all. The rest of the triple-treated did, but had tiny amounts of cancer to remove, while the double-treated had about 50% left.

Basically, having two immunotherapy drugs made the difference.

All of this is available, today.

[ConservativeMind]

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