Adding Opdivo to Chemo Boosts Survival in NSCLC

Pathological complete response was 37% in patients in the Opdivo/chemotherapy group and 7% in the chemotherapy-only group.

While research shows that approximately 20% of non-small cell lung cancer (NSCLC) diagnoses are made at stage 3, a consensus is still lacking regarding the best treatment option for this patient population. However, recent findings showed that pre- and post-surgical Opvido (nivolumab) may be a promising option.

A recent phase 2 clinical trial had the goal of determining if adding Opdivo to pre-surgical platinum-based chemotherapy — a commonly used type of chemotherapy — would improve outcomes in patients with stage 3A or 3B NSCLC. The study included a total of 86 patients: 57 were randomly assigned to receive Opdivo plus chemotherapy (carboplatin plus paclitaxel) followed by surgery and more Opdivo treatment, while 29 received the chemotherapy regimen alone before surgery.

Opdivo is an immunotherapy agent — more specifically, a checkpoint inhibitor — that works by blocking a certain protein found on cancer cells that helps them hide from the immune system. By blocking the protein, the tumors then become noticed by the immune system, which can find and attack them.

Patients were deemed not eligible for the trial if they: had alterations in the EGFR or ALK gene(s); had an autoimmune disease, vitiligo, type 1 diabetes or other health conditions; had another condition being treated with corticosteroids; had interstitial lung disease or poor lung function; had another cancer; had prior immunotherapy treatment; had hepatitis B; were of childbearing age and not willing to use a contraceptive or were breastfeeding.

Findings, which were published in the New England Journal of Medicine, showed that a pathological complete response — which, according to the Food and Drug Administration, is the absence of cancer in resected tissue and lymph nodes — was 37% in patients in the Opdivo/chemotherapy group and 7% in the chemotherapy-only group.

Study findings also showed that a higher percentage of patients who received Opdivo ended up undergoing surgery than those who only received chemotherapy, at 93% and 69%,respectively. Additionally, 24-month progression-free survival (which shows the percentage of patients who are still alive and did not experience their cancer worsening after two years) was 67.2% in the Opdivo group and 40.9% in the chemotherapy group.

After 24 months, 85% of patients who received Opdivo plus chemotherapy were still alive, compared with 63.6% in the chemotherapy-alone group.

“In patients with resectablestage 3A or 3B NSCLC, perioperative treatment with (Opdivo) plus chemotherapy resulted in a higher percentage of patients with a pathological complete response and longer survival than chemotherapy alone,” the researchers wrote.

Immunotherapy is becoming increasingly popular in the treatment of solid cancers, including lung cancer.

READ MORE: The Way of the Future for Treating Early-Stage NSCLC

However, like nearly all cancer treatments, immunotherapy drugs like Opdivo can come with side effects, too. Since the drug activates the immune system, inflammation can happen within any organ system. That said, one expert emphasized the importance of patients informing their cancer care team sooner rather than later if they experience any side effects, which can include gastrointestinal upset (diarrhea, etc), skin rashes and more. These toxicities, especially when caught early, can be managed with corticosteroids, a type of drug that suppresses the immune system.

Regarding side effects observed in this study, there was a higher instance of moderate to severe (grade 3 or 4) side effects in the group of patients who received Opdivo, compared to those who received chemotherapy only, at 19% and 10%, respectively.

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