Safety of First-Line Nivolumab Plus Ipilimumab in Patients With Metastatic NSCLC: A Pooled Analysis of CheckMate 227, CheckMate 568, and CheckMate 817

• Published in: Journal of thoracic oncology 2023-01, Vol.18 (1), p.79-92
• Main Authors: Paz-Ares, Luis G., Ciuleanu, Tudor-Eliade, Pluzanski, Adam, Lee, Jong-Seok, Gainor, Justin F., Otterson, Gregory A., Audigier-Valette, Clarisse, Ready, Neal, Schenker, Michael, Linardou, Helena, Caro, Reyes Bernabe, Provencio, Mariano, Zurawski, Bogdan, Lee, Ki Hyeong, Kim, Sang-We, Caserta, Claudia, Ramalingam, Suresh S., Spigel, David R., Brahmer, Julie R., Reck, Martin, O’Byrne, Kenneth J., Girard, Nicolas, Popat, Sanjay, Peters, Solange, Memaj, Arteid, Nathan, Faith, Aanur, Nivedita, Borghaei, Hossein
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Non-Small-Cell Lung - chemically induced; Carcinoma, Non-Small-Cell Lung - drug therapy; Humans; Immune-mediated adverse events; Ipilimumab; Ipilimumab - pharmacology; Ipilimumab - therapeutic use; Lung Neoplasms - pathology; Nivolumab; Nivolumab - pharmacology; Nivolumab - therapeutic use; NSCLC; Safety
• ISSN: 1556-0864; 1556-1380; 1556-1380
• DOI: 10.1016/j.jtho.2022.08.014

We characterized the safety of first-line nivolumab plus ipilimumab (NIVO+IPI) in a large patient population with metastatic NSCLC and efficacy outcomes after NIVO+IPI discontinuation owing to treatment-related adverse events (TRAEs). We pooled data from three first-line NIVO+IPI studies (NIVO, 3 mg/kg or 240 mg every 2 wk; IPI, 1 mg/kg every 6 wk) in metastatic NSCLC (CheckMate 227 part 1, CheckMate 817 cohort A, CheckMate 568 part 1). Safety end points included TRAEs and immune-mediated adverse events (IMAEs) in the pooled population and patients aged 75 years or older. In the pooled population (N = 1255), any-grade TRAEs occurred in 78% of the patients, grade 3 or 4 TRAEs in 34%, and discontinuation of any regimen component owing to TRAEs in 21%. The most frequent TRAE and IMAE were diarrhea (20%; grade 3 or 4, 2%) and rash (17%; grade 3 or 4, 3%), respectively. The most common grade 3 or 4 IMAEs were hepatitis (5%) and diarrhea/colitis and pneumonitis (4% each). Pneumonitis was the most common cause of treatment-related death (5 of 16). Safety in patients aged 75 years or older (n = 174) was generally similar to the overall population, but discontinuation of any regimen component owing to TRAEs was more common (29%). In patients discontinuing NIVO+IPI owing to TRAEs (n = 225), 3-year overall survival was 50% (95% confidence interval: 42.6–56.0), and 42% (31.2–52.4) of 130 responders remained in response 2 years after discontinuation. First-line NIVO+IPI was well tolerated in this large population with metastatic NSCLC and in patients aged 75 years or older. Discontinuation owing to TRAEs did not reduce long-term survival.