West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany.
Medical Faculty, University Duisburg-Essen, Essen, Germany.
Nat Med. 2024 Jun;30(6):1602-1611. doi: 10.1038/s41591-024-02965-0. Epub 2024 Apr 30.
Antibodies targeting the immune checkpoint molecules PD-1, PD-L1 and CTLA-4, administered alone or in combination with chemotherapy, are the standard of care in most patients with metastatic non-small-cell lung cancers. When given before curative surgery, tumor responses and improved event-free survival are achieved. New antibody combinations may be more efficacious and tolerable. In an ongoing, open-label phase 2 study, 60 biomarker-unselected, treatment-naive patients with resectable non-small-cell lung cancer were randomized to receive two preoperative doses of nivolumab (anti-PD-1) with or without relatlimab (anti-LAG-3) antibody therapy. The primary study endpoint was the feasibility of surgery within 43 days, which was met by all patients. Curative resection was achieved in 95% of patients. Secondary endpoints included pathological and radiographic response rates, pathologically complete resection rates, disease-free and overall survival rates, and safety. Major pathological (≤10% viable tumor cells) and objective radiographic responses were achieved in 27% and 10% (nivolumab) and in 30% and 27% (nivolumab and relatlimab) of patients, respectively. In 100% (nivolumab) and 90% (nivolumab and relatlimab) of patients, tumors and lymph nodes were pathologically completely resected. With 12 months median duration of follow-up, disease-free survival and overall survival rates at 12 months were 89% and 93% (nivolumab), and 93% and 100% (nivolumab and relatlimab). Both treatments were safe with grade ≥3 treatment-emergent adverse events reported in 10% and 13% of patients per study arm. Exploratory analyses provided insights into biological processes triggered by preoperative immunotherapy. This study establishes the feasibility and safety of dual targeting of PD-1 and LAG-3 before lung cancer surgery.ClinicalTrials.gov Indentifier: NCT04205552 .
针对免疫检查点分子 PD-1、PD-L1 和 CTLA-4 的抗体,单独或与化疗联合使用,是大多数转移性非小细胞肺癌患者的标准治疗方法。当在根治性手术前使用时,可以达到肿瘤反应和改善无事件生存。新的抗体组合可能更有效和耐受。在一项正在进行的、开放性的 2 期研究中,60 名未经选择的、未经治疗的可切除非小细胞肺癌患者被随机分配接受两剂术前纳武单抗(抗 PD-1)加或不加 relatlimab(抗 LAG-3)抗体治疗。主要研究终点是在 43 天内进行手术的可行性,所有患者均达到。95%的患者实现了根治性切除。次要终点包括病理和影像学反应率、病理完全切除率、无病和总生存率以及安全性。主要的病理(≤10%存活肿瘤细胞)和客观的影像学反应分别在 27%和 10%(纳武单抗)和 30%和 27%(纳武单抗和 relatlimab)的患者中达到。在 100%(纳武单抗)和 90%(纳武单抗和 relatlimab)的患者中,肿瘤和淋巴结均被病理完全切除。在 12 个月的中位随访时间内,无病生存率和总生存率在 12 个月时分别为 89%和 93%(纳武单抗),93%和 100%(纳武单抗和 relatlimab)。两种治疗方法均安全,每个研究臂均有 10%和 13%的患者出现≥3 级治疗相关不良事件。探索性分析提供了术前免疫治疗引发的生物学过程的见解。这项研究确立了在肺癌手术前双重靶向 PD-1 和 LAG-3 的可行性和安全性。ClinicalTrials.gov 标识符:NCT04205552。