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Combining Chemo With Immunotherapy Does Not Improve OS in Patients with NSCLC
For patients with stage IV non-small-cell lung cancer (NSCLC), adding chemotherapy to first-line durvalumab plus tremelimumab improved progression-free survival (PFS) but did not improve overall survival (OS) when compared to durvalumab plus tremelimumab alone (J Thorac Oncol.:S1556-0864(21)03322-0.).
“First-line therapy for patients with metastatic NSCLC includes checkpoint inhibitor monotherapy, dual checkpoint inhibition, or in combination with chemotherapy. We compared outcomes with combination chemoimmunotherapy versus dual checkpoint inhibition as first-line treatment for patients with metastatic NSCLC,” explained Natasha B. Leighl, MD, Princess Margaret Cancer Centre Professor of Medicine, University of Toronto, Canada, and colleagues.
The open-label, randomized clinical trial included treatment-naive, metastatic NSCLC patients, without sensitizing EGFR or ALK alterations, from across 44 sites in Canada and Australia. Patients were randomized 1:1 to receive durvalumab plus tremelimumab with or without platinum doublet chemotherapy.
The primary endpoint was OS, while secondary endpoints included PFS, overall response rate (ORR), and safety.
A total of 301 patients were randomized. The median OS in the chemotherapy plus immunotherapy arm was 16.6 months (95%CI, 12.6-19.1), and the median PFS was 7.7 months (95%CI, 5.5-8.5). Comparatively, the median OS and PFS in the immunotherapy arm were 14.1 months (95%CI, 10.6-18.3) and 3.2 months (95%CI, 2.7-5.1), respectively. The ORR with chemoimmunotherapy was 42.4% and 29.3% with immunotherapy (adjusted odds ratio 1.69, 95%CI, 1.04-2.76).
Furthermore, 82% of patients in the chemoimmunotherapy arm experienced adverse events of grade 3 or higher, compared to 70% in the immunotherapy group.
“The addition of chemotherapy to durvalumab plus tremelimumab in the first-line treatment of stage IV NSCLC did not improve survival compared to durvalumab plus tremelimumab alone,” concluded Dr Leighl et al. —Alexandra Graziano
