Margaret K. Callahan, Michael A. Postow, Neil H. Segal, Alexander Lesokhin, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Harriet Kluger and Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, and Yale-New Haven Hospital, New Haven, CT; Michael B. Atkins, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; and Suba Krishnan, Rafia Bhore, and Christine Horak, Bristol-Myers Squibb, Princeton, NJ.
J Clin Oncol. 2018 Feb 1;36(4):391-398. doi: 10.1200/JCO.2017.72.2850. Epub 2017 Oct 17.
Purpose The clinical activity observed in a phase I dose-escalation study of concurrent therapy with nivolumab (NIVO) and ipilimumab (IPI) in patients with previously treated or untreated advanced melanoma led to subsequent clinical development, including randomized trials. Here, we report long-term follow-up data from study CA209-004, including 3-year overall survival (OS). Patients and Methods Concurrent cohorts 1, 2, 2a, and 3 received escalating doses of NIVO plus IPI once every 3 weeks for four doses, followed by NIVO once every 3 weeks for four doses, then NIVO plus IPI once every 12 weeks for eight doses. An expansion cohort (cohort 8) received concurrent NIVO 1 mg/kg plus IPI 3 mg/kg once every 3 weeks for four doses, followed by NIVO 3 mg/kg once every 2 weeks, which is the dose and schedule used in phase II and III studies and now approved for patients with unresectable or metastatic melanoma. Results Among all concurrent cohorts (N = 94) at a follow-up of 30.3 to 55.0 months, the 3-year OS rate was 63% and median OS had not been reached. Objective response rate by modified WHO criteria was 42%, and median duration of response was 22.3 months. Incidence of grade 3 and 4 treatment-related adverse events was 59%. The most common grade 3 and 4 treatment-related adverse events were increases in lipase (15%), alanine aminotransferase (12%), and aspartate aminotransferase (11%). One treatment-related death (1.1%) occurred in a patient who had multiorgan failure 70 days after the last dose of NIVO plus IPI. Conclusion This is the longest follow-up for NIVO plus IPI combination therapy in patients with advanced melanoma. The 3-year OS rate of 63% is the highest observed for this patient population and provides additional evidence for the durable clinical activity of immune checkpoint inhibitors in the treatment of advanced melanoma.
目的:在一项nivolumab(NIVO)和 ipilimumab(IPI)联合治疗既往治疗或未经治疗的晚期黑色素瘤患者的 I 期剂量递增研究中观察到的临床活性导致了随后的临床开发,包括随机试验。在这里,我们报告了研究 CA209-004 的长期随访数据,包括 3 年总生存率(OS)。
方法:同时进行的队列 1、2、2a 和 3 接受递增剂量的 NIVO 加 IPI 每 3 周一次,共 4 个剂量,然后每 3 周一次 NIVO 加 IPI 共 4 个剂量,然后每 12 周一次 NIVO 加 IPI 共 8 个剂量。扩展队列(队列 8)接受同时给予 NIVO 1mg/kg 加 IPI 3mg/kg,每 3 周一次,共 4 个剂量,然后每 2 周一次给予 NIVO 3mg/kg,这是目前在 II 期和 III 期研究中使用的剂量和方案,现已批准用于不可切除或转移性黑色素瘤患者。
结果:在随访 30.3 至 55.0 个月的所有同时队列(N = 94)中,3 年 OS 率为 63%,中位 OS 尚未达到。根据改良的 WHO 标准,客观缓解率为 42%,中位缓解持续时间为 22.3 个月。3 级和 4 级治疗相关不良事件的发生率为 59%。最常见的 3 级和 4 级治疗相关不良事件是脂肪酶升高(15%)、丙氨酸氨基转移酶升高(12%)和天冬氨酸氨基转移酶升高(11%)。一名患者在接受 NIVO 加 IPI 治疗后 70 天发生多器官衰竭,导致 1 例与治疗相关的死亡(1.1%)。
结论:这是晚期黑色素瘤患者接受 NIVO 加 IPI 联合治疗的最长随访时间。63%的 3 年 OS 率是该患者人群观察到的最高水平,为免疫检查点抑制剂在治疗晚期黑色素瘤中的持久临床活性提供了额外证据。
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