Neoadjuvant nivolumab with or without relatlimab in resectable non-small-cell lung cancer: a randomized phase 2 trial

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Martin Schuler - , University of Duisburg-Essen, National Center for Tumor Diseases (NCT) West (Author)
  • Kristof Cuppens - , Jessa Hospital, Hasselt University (Author)
  • Till Plönes - , Department of Visceral, Thoracic and Vascular Surgery, University of Duisburg-Essen, University Hospital Essen, University Hospital Carl Gustav Carus Dresden (Author)
  • Marcel Wiesweg - , University of Duisburg-Essen, National Center for Tumor Diseases (NCT) West (Author)
  • Bert Du Pont - , Jessa Hospital (Author)
  • Balazs Hegedus - , University of Duisburg-Essen (Author)
  • Johannes Köster - , University of Duisburg-Essen, National Center for Tumor Diseases (NCT) West (Author)
  • Fabian Mairinger - , University of Duisburg-Essen (Author)
  • Kaid Darwiche - , University of Duisburg-Essen, National Center for Tumor Diseases (NCT) West (Author)
  • Annette Paschen - , University of Duisburg-Essen (Author)
  • Brigitte Maes - , Jessa Hospital (Author)
  • Michel Vanbockrijck - , Jessa Hospital (Author)
  • David Lähnemann - , University of Duisburg-Essen (Author)
  • Fang Zhao - , University of Duisburg-Essen (Author)
  • Hubertus Hautzel - , University of Duisburg-Essen, National Center for Tumor Diseases (NCT) West (Author)
  • Dirk Theegarten - , University of Duisburg-Essen (Author)
  • Koen Hartemink - , Antoni van Leeuwenhoek Hospital (Author)
  • Henning Reis - , University of Duisburg-Essen, University Hospital Frankfurt (Author)
  • Paul Baas - , Antoni van Leeuwenhoek Hospital (Author)
  • Alexander Schramm - , University of Duisburg-Essen (Author)
  • Clemens Aigner - , University of Duisburg-Essen, Medical University of Vienna (Author)

Abstract

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.

Details

Original languageEnglish
Pages (from-to)1602-1611
Number of pages10
JournalNature medicine
Volume30
Issue number6
Publication statusPublished - Jun 2024
Peer-reviewedYes

External IDs

PubMed 38689060

Keywords

Sustainable Development Goals

Keywords

  • Humans, Carcinoma, Non-Small-Cell Lung/drug therapy, Nivolumab/therapeutic use, Female, Male, Middle Aged, Lung Neoplasms/drug therapy, Neoadjuvant Therapy, Aged, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Lymphocyte Activation Gene 3 Protein, Adult, Antibodies, Monoclonal, Humanized/therapeutic use, Antigens, CD, Aged, 80 and over