Dr. Ready on Leveraging Nivolumab/Ipilimumab Plus Chemotherapy in NSCLC

Neal Edward Ready, MD, PhD, professor of Medicine, member, Duke Cancer Institute, discusses factors to consider when deciding when the use the regimen of nivolumab (Opdivo) and ipilimumab (Yervoy) plus chemotherapy in metastatic non–small cell lung cancer (NSCLC).

The phase 3 CheckMate-9LA trial (NCT03215706) evaluated nivolumab and ipilimumab plus chemotherapy vs chemotherapy alone in the first-line treatment of patients with metastatic NSCLC. Updated data from the trial, which were presented during the 2022 ASCO Annual Meeting, showed that the chemoimmunotherapy combination continued to provide prolonged overall survival (OS) benefit compared with chemotherapy alone, according to Ready.

If a patient has low a PD-L1 expression, but has a high tumor burden and is symptomatic, Ready shares that he would leverage the CheckMate-9LA combination of nivolumab and ipilimumab with chemotherapy rather than immunotherapy alone.

Clinicians may be concerned about combining a PD-1 checkpoint inhibitor with a CTLA-4 inhibitor, according to Ready, since earlier regimens examined in melanoma reported substantial toxicity. This concern is especially prominent when considering this approach for an older population with NSCLC who could have more comorbidities, Ready adds. However, the CheckMate trials deliberately and methodically identified the combination of nivolumab plus ipilimumab that was tolerable in patients with NSCLC, Ready concludes.