Clinical Epidemiology and Ageing

Duration of nivolumab for pretreated, advanced non-small-cell lung cancer.

Geier M, Descourt R, Corre R, Léveiller G, Lamy R, Goarant E, Bizec J-L, Bernier C, Quere G, Amrane K, Gaye E, Lucia F, Burte E, Chouaid C, Robinet G Cancer Med. 2020;9(19):6923-6932.

BACKGROUND: A standard of care for pretreated, advanced non-small-cell lung cancers (NSCLCs), nivolumab has demonstrated long-term benefit when administered for 2 years. We aimed to better discern an optimized administration duration by retrospectively analyzing real-life long-term efficacy in a prospective cohort.

METHODS: All nivolumab-treated adults with advanced NSCLCs (01/09/2015 to 30/09/2016) from nine French centers were eligible. On 31/12/2018, patients who are alive ≥ 2 years after starting nivolumab were defined as long-term survivors (LTSs) and were divided into three nivolumab treatment groups: <2, 2, or > 2 years. Co-primary endpoints were LTSs' progression-free survival (PFS) and overall survival (OS).

RESULTS: The median follow-up was 32 months (95% CI, 31.0 to 34.0). The 3-year OS rate for the 259 cohort patients was 16.6%. Among them, 65 were LTSs: 47 treated < 2 years, 7 for 2 years, and 11 > 2 years. Their respective characteristics were: median age: 59, 52, and 58 years; smoking history: 92.9, 100, and 100%; adenocarcinomas: 66, 57.1, and 54.5%. LTSs' median (m)PFS was 28.4 months; mOS was not reached. LTSs' objective response rate was 61.6%. mOS was 32.7 months for those treated < 2 years and not reached for the others. The > 2-year group's 3-year OS was longer. Twenty-eight LTSs experienced no disease progression; 7 had durable complete responses. However, LTSs had more frequent and more severe adverse events.

CONCLUSION: In real-life, prolonged nivolumab use provided long-term benefit with 16.6% 3-year OS and 25% LTSs. Survival tended to be prolonged with nivolumab continued beyond 2 years. Prospective randomized trials with adequate design are needed.

MeSH terms: Adult; Aged; Aged, 80 and over; Cancer Survivors; Carcinoma, Non-Small-Cell Lung; Female; France; Humans; Immune Checkpoint Inhibitors; Lung Neoplasms; Male; Middle Aged; Nivolumab; Progression-Free Survival; Retrospective Studies; Time Factors
DOI: 10.1002/cam4.3120