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Addition of stereotactic ablative radiotherapy to nivolumab improves lung cancer survival
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CHICAGO — The combination of stereotactic ablative radiotherapy plus anti-PD-1 therapy improved survival among patients with advanced lung cancer, according to a retrospective analysis presented at the International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology.
Immune checkpoint inhibitors have improved outcomes in non-small cell lung cancer. However, the absolute improvement over docetaxel is only 3 to 5 months for median OS and 15% to 20% for overall response rate.
Preclinical trials have demonstrated radiotherapy enhances anti-PD-1 therapy-mediated antitumor effects.
Aparna Hegde, MD, chief research fellow at East Carolina University, and colleagues evaluated the combination of stereotactic ablative radiotherapy plus nivolumab (Opdivo, Bristol-Myers Squibb) to determine OS and independent predictive factors for mortality in this patient population.
Of 109 patients with advanced lung cancer treated with nivolumab, 24 patients received stereotactic ablative radiotherapy within 30 days preceding (n = 14) and during treatment (n = 10).
After a median follow-up of 14.6 months, patients treated with stereotactic ablative radiotherapy during treatment demonstrated superior survival outcomes compared with those who received radiotherapy before treatment or did not undergo radiotherapy.
Patients who received stereotactic ablative radiotherapy during nivolumab treatment demonstrated a 1-year OS rate of 54%, with a median OS of 17.2 months (HR = 0.34; 95% CI, 0.14-0.79).
Patients who received stereotactic ablative radiotherapy preceding nivolumab treatment demonstrated a 1-year OS rate of 43%, with a median OS of 11.1 months (HR = 0.61; 95% CI, 0.28-1.36).
Patients who did not receive stereotactic ablative radiotherapy only achieved a 1-year OS rate of 25%, with a median OS of 5.6 months.
Hegde noted the improvement in survival with stereotactic ablative radiotherapy may have been caused by better local disease control or abscopal effect by in-situ tumor vaccination.
Univariate analysis showed five or more cycles of nivolumab treatment, ECOG performance status of 2 or higher, and stereotactic ablative radiotherapy were independent predictors of mortality.
Grade 3 or 4 serious adverse events appeared similar in patients treated with the combination regimen compared with nivolumab alone.
“The dose, fractionation and sequence of stereotactic ablative radiotherapy with anti-PD-1 therapy need further evaluation,” Hegde said. – by Kristie L. Kahl
Reference:
Hegde A, et al. Abstract 3A.01. Presented at International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology; Sept. 14-16, 2017; Chicago.
Disclosure: Hegde reports no relevant financial disclosures.