Nivolumab more active in lymph nodes
Immunotherapy has differential effects at different organ sites of metastases. In a study by Schmid S et al. (abstract P2.07-012), Nivolumab treatment appeared to be more active in immune cells (IC) rich organs than at IC intermediate and IC poor sites. The results suggest that the combination of immune checkpoint inhibitors with local treatment strategies to IC intermediate or poor organs should be explored.
The study retrospectively analysed serial computed tomography (CT) scans of patients treated with nivolumab applying RECIST 1.1 criteria to assess overall response (ORR) and response in different organ sites. ¬ CT examinations were performed on a 3rd generation dual-source CT system and read by two experienced radiologists. Metastatic sites from NSCLC were classified into three groups: 1) IC rich: lymph nodes, 2) IC intermediate: liver, lungs, 3) IC poor: bone, soft tissue. Standard descriptive statistics were used; time-to-event endpoints were analyzed using Kaplan-Meier methods.
52 patients with advanced NSCLC were analyzed. Median age was 66 years, 44 % were female, 58 % had adenocarcinoma, 92 % were former or current smokers. Prior to nivolumab treatment start patients had lesions in the lung (42 %), liver (25 %), lymph node (56 %), soft tissue (13 %) and bone (23 %). In 62 % of the patients the primary tumor was still in situ. ORR and disease-control-rate (DCR) were 20 % and 45 %, respectively. Median overall survival was 11.9 months, median progression-free survival was 2.3 months and median duration of response (DOR) 10.3 months. Response (RR) to nivolumab differed depending on organ site: RR and DCR according to organ sites were 28 % and 90 % in lymph nodes, classified as IC rich. RR was 8 %, 9 % and 16 % and DCR was 58 %, 55 % and 81 % in liver, lung metastases and primary tumor, respectively, classified as IC intermediate. In IC poor organs RR was 0 % in soft tissue metastases and nine out of 12 patients with bone metastases, which included non-measurable non-target lesions only, had progressive lesions at time of overall tumor progression.
Schmid S et al., abstract P2.07-012: Patterns of Response to Nivolumab in Patients with Non-Small Cell Lung Cancer (NSCLC)