Dr Donington on the Evolving Use of Perioperative Nivolumab in Resectable NSCLC

“The cDNA data were good, maybe not as good as what we’ve seen with other trials. But still, this is a real marker that eventually, within the next 5, maybe 7 years, should be good enough to help direct therapy.”

Jessica Donington, MD, MSCR, a professor of surgery and the chief of the Section of Thoracic Surgery at the University of Chicago Medicine, discusses the future surgical implications of updated data from the phase 3 CheckMate 77T trial (NCT04025879) of perioperative nivolumab (Opdivo) vs placebo in patients with resectable non–small cell lung cancer (NSCLC), as well as remaining questions regarding the optimal use of immunotherapy in this population.

The CheckMate 77T trial builds upon the findings from the phase 3 CheckMate 816 study (NCT02998528) by incorporating both neoadjuvant and adjuvant immunotherapy components. Current data from CheckMate 77T remain promising, according to Donington. Specifically, the trial continues to demonstrate an improvement in event-free survival among patients with NSCLC receiving immunotherapy in combination with chemotherapy vs those who received chemotherapy plus placebo. Additionally, surgical outcomes in this cohort have been favorable.

Several important biomarker analyses have also been presented from the trial, including those involving circulating tumor DNA (ctDNA), Donington said. Although the ctDNA findings were not as robust as those reported in some other trials, they remain clinically meaningful, she noted. ctDNA appears to be an emerging biomarker with the potential to inform therapeutic decisions, she stated. Although it is not yet ready for routine clinical use, it may become a reliable tool for guiding treatment strategies within the next 5 to 7 years, she explained.

Another aspect of the trial involved evaluation of molecular alterations traditionally associated with limited responsiveness to immunotherapy—specifically mutations in genes like STK11 and KEAP1, Donington continued. Notably, patients with tumors harboring these mutations still derived clinical benefit from the addition of immunotherapy, suggesting that these molecular markers alone should not be used to exclude patients from immunotherapy-based regimens, she concluded.