纳武利尤单抗和伊匹单抗联合治疗晚期黑色素瘤患者的汇总分析安全性概况。
Pooled Analysis Safety Profile of Nivolumab and Ipilimumab Combination Therapy in Patients With Advanced Melanoma.
机构信息
Mario Sznol, Yale Comprehensive Cancer Center, New Haven, CT; Pier Francesco Ferrucci, Istituto Europeo di Oncologia, Milan; Massimo Guidoboni, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy; David Hogg, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Michael B. Atkins, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Pascal Wolter, University Hospitals Leuven, Leuven, Belgium; Celeste Lebbé, Université Paris Diderot, Paris; Luc Thomas, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; John M. Kirkwood, Hillman Cancer Center, Pittsburgh, PA; Jacob Schachter, Sheba Medical Center, Ramat Gan, Israel; Gregory A. Daniels, University of California San Diego, Moores Cancer Center, La Jolla, CA; Jessica Hassel, University Hospital, Heidelberg, Germany; Jonathan Cebon, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria; Winald Gerritsen, University of Queensland, St Lucia; Victoria Atkinson, Gallipoli Medical Research Foundation, Greenslopes; Victoria Atkinson, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Winald Gerritsen, Radboud University Medical Center, Nijmegen, the Netherlands; John McCaffrey, Irish Clinical Oncology Research Group, Dublin; Derek Power, Irish Clinical Oncology Research Group, Cork, Ireland; Dana Walker, Rafia Bhore, and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; and Jedd D. Wolchok, Parker Institute and Ludwig Center at Memorial Sloan Kettering Cancer Center, New York, NY.
出版信息
J Clin Oncol. 2017 Dec 1;35(34):3815-3822. doi: 10.1200/JCO.2016.72.1167. Epub 2017 Sep 15.
Purpose The addition of nivolumab (anti-programmed death-1 antibody) to ipilimumab (anti-cytotoxic T-cell lymphocyte-associated 4 antibody) in patients with advanced melanoma improves antitumor response and progression-free survival but with a higher frequency of adverse events (AEs). This cross-melanoma study describes the safety profile of the approved nivolumab plus ipilimumab regimen. Methods This retrospective safety review on data from three trials (phase I, II, and III) included patients with advanced melanoma who received at least one dose of nivolumab 1 mg/kg plus ipilimumab 3 mg/kg every 3 weeks × 4 and then nivolumab 3 mg/kg every 2 weeks until disease progression or unacceptable toxicity while following established guidelines for AE management. Analyses were of all treatment-related AEs, select (immune-related) AEs, time to onset and resolution, and use of immune-modulating agents and their effects on outcome. Results Among 448 patients, median duration of follow-up was 13.2 months. Treatment-related grade 3/4 AEs occurred in 55.5% of patients; 35.7% had treatment-related AEs that led to discontinuation. The most frequent treatment-related select AEs of any grade were skin (64.3%) and GI (46.7%) and of grade 3/4, hepatic (17.0%) and GI (16.3%); 30.1% developed a grade 2 to 4 select AE in more than one organ category. Median time to onset of grade 3/4 treatment-related select AEs ranged from 3.1 (skin) to 16.3 (renal) weeks, and with the exclusion of endocrine AEs, median time to resolution from onset ranged from 1.9 (renal) to 4.5 (pulmonary) weeks, with resolution rates between 79% and 100% while using immune-modulating agents. Four (< 1%) on-study deaths were attributed to therapy. Conclusion Frequency of grade 3/4 treatment-related AEs was higher with nivolumab plus ipilimumab and occurred earlier than historical experience with either agent alone, but resolution rates were similar.
目的
纳武利尤单抗(抗程序性死亡-1 抗体)联合伊匹单抗(抗细胞毒性 T 淋巴细胞相关抗原 4 抗体)用于晚期黑色素瘤患者可提高抗肿瘤反应和无进展生存期,但不良反应(AE)发生率更高。这项跨黑色素瘤研究描述了已批准的纳武利尤单抗联合伊匹单抗方案的安全性概况。
方法
本回顾性安全性分析的数据来自三项试验(I 期、II 期和 III 期),纳入至少接受过一次纳武利尤单抗 1mg/kg 联合伊匹单抗 3mg/kg,每 3 周 1 次×4 次,然后每 2 周 1 次纳武利尤单抗 3mg/kg,直至疾病进展或不可接受的毒性,同时遵循 AE 管理的既定指南。分析包括所有治疗相关 AE、选择(免疫相关)AE、发病时间和缓解时间,以及免疫调节药物的使用及其对结局的影响。
结果
在 448 例患者中,中位随访时间为 13.2 个月。55.5%的患者发生治疗相关 3/4 级 AE;35.7%的患者因治疗相关 AE 而停药。任何级别最常见的治疗相关选择 AE 为皮肤(64.3%)和胃肠道(46.7%),3/4 级为肝脏(17.0%)和胃肠道(16.3%);30.1%的患者在一个以上器官类别中发生 2 至 4 级选择 AE。3/4 级治疗相关选择 AE 的中位发病时间为 3.1(皮肤)至 16.3(肾脏)周,排除内分泌 AE 后,从发病到缓解的中位时间为 1.9(肾脏)至 4.5(肺部)周,缓解率为 79%至 100%,同时使用免疫调节药物。4 例(<1%)研究期间死亡归因于治疗。
结论
纳武利尤单抗联合伊匹单抗治疗相关 3/4 级 AE 发生率高于单独使用任一药物,且发病更早,但缓解率相似。