Cancer Treatment Today

There are two recently published studies on the use of Opdivo for small cell lung cancer.

In the first study, CheckMate-032, patients with pretreated SCLC received either the PD-1 inhibitor nivolumab (Opdivo) or a combination of Opdivo and the CTLA-4 inhibitor ipilimumab (Yervoy). Of the patients who received only Opdivo, 12.7% showed a partial decrease or disappearance of the signs of their disease (objective response rate, or ORR); 16.4% of the Opdivo-only patients had stable disease (SD). For patients who received both Opdivo and Yervoy, the ORR was 31.1%, with a 2.2% complete response rate There are two recently published studies on the use of Opdivo for small cell lung cancer. In the first study, CheckMate-032, patients with pretreated SCLC received either the PD-1 inhibitor nivolumab (Opdivo) or a combination of Opdivo and the CTLA-4 inhibitor ipilimumab (Yervoy). Of the patients who received only Opdivo, 12.7% showed a partial decrease or disappearance of the signs of their disease (objective response rate, or ORR); 16.4% of the Opdivo-only patients had stable disease (SD). For patients who received both Opdivo and Yervoy, the ORR was 31.1%, with a 2.2% complete response rate (no more signs of disease). The SD rate for the combination was 22.2%. One-year survival rates were 27.1% and 47.5% for the Opdivo-only and combination groups, respectively.

NCCN does list nivolumab with or withour iplipumab in SCL-C, 1, but it it does not list ipililumab alone or after the above combination.

REFERENCES:
Scott Joseph Antonia et al, Phase I/II study of nivolumab with or without ipilimumab for treatment of recurrent small cell lung cancer (SCLC): CA209-032.J Clin Oncol 33, 2015 (suppl; abstr 7503)

Patrick Alexander Ott et al,Pembrolizumab (MK-3475) in patients (pts) with extensive-stage small cell lung cancer (SCLC): Preliminary safety and efficacy results from KEYNOTE-028.J Clin Oncol 33, 2015 (suppl; abstr 7502)

(no more signs of disease). The SD rate for the combination was 22.2%. One-year survival rates were 27.1% and 47.5% for the Opdivo-only and combination groups, respectively. This is encouraging compared to historic data on the survival of SCLC patients treated with chemotherapy.

In the smaller KEYNOTE-028 clinical trial, 24 SCLC patients received thesimilar PD-1 inhibitor pembrolizumab (Keytruda). The ORR was 29.2% (all were partial responses, PR), and the SD rate was 4.2%. These results are encouraging, but combining PD-1 inhibitors with other treatments (chemotherapy, radiotherapy, or targeted drugs) is the next step in trying to improve the efficacy of PD-1 blockers in SCLC; several clinical trials are already testing this (NCT02402920, NCT02481830, NCT02472977, NCT02331251, NCT02551432).

Scott Joseph Antonia et al, Phase I/II study of nivolumab with or without ipilimumab for treatment of recurrent small cell lung cancer (SCLC): CA209-032.J Clin Oncol 33, 2015 (suppl; abstr 7503)

Patrick Alexander Ott et al,Pembrolizumab (MK-3475) in patients (pts) with extensive-stage small cell lung cancer (SCLC): Preliminary safety and efficacy results from KEYNOTE-028.J Clin Oncol 33, 2015 (suppl; abstr 7502)