Dr. Ready on the Practice Implications of Nivolumab/Ipilimumab in NSCLC

Neal Edward Ready, MD, PhD, professor of Medicine, member, Duke Cancer Institute, discusses the practice implications of nivolumab (Opdivo) plus ipilimumab (Yervoy) in patients with metastatic non–small cell lung cancer (NSCLC).

The phase 3 CheckMate-227 trial (NCT02477826) examined single-agent nivolumab, nivolumab plus ipilimumab, and nivolumab plus platinum-doublet chemotherapy vs platinum-doublet chemotherapy alone to evaluate progression-free survival (PFS) and overall survival (OS) in patients with advanced NSCLC.

Patients with a PD-L1 expression below 50% tend to do worse with immunotherapy, Ready says. In those PD-L1–low patients, smoking history, squamous vs nonsquamous cell, and tumor mutational burden are factors to consider when determining treatment, Ready adds.

When patients have neoantigens or peptides produced by mutated genes, T cells have the potential to recognize them, and these patients may receive more benefit from the CheckMate-227 regimen of nivolumab plus ipilimumab, Ready adds. If there is a high level of neoantigens, there is a better chance to jumpstart a patient’s immune system to get a more meaningful response, Ready concludes.