![]() ![]() In the durvalumab-chemotherapy it was 5.5 months median PFS vs 4.8 with chemotherapy, and 13.3 months of median OS with the durvalumab-chemotherapy and 11.7 in the chemotherapy arm. A little less than 40% were squamous histology. What’s interesting is that…a higher percentage of patients were squamous, around 40%. It’s a little better regimen to tolerate, I guess, compared with every 6 weeks of ipilimumab. Tremelimumab was given every 16 weeks after the full cycles of every-3-week dosing of tremelimumab. The key difference, as you pointed out, was the maintenance pemetrexed…. It’s randomized 1:1 durvalumab plus chemotherapy vs durvalumab-tremelimumab plus chemotherapy and platinum doublet as a control arm. Vamsidhar Velcheti, MD: The POSEIDON study is along the lines of CheckMate 9LA but with some key differences. ![]() Vamsi, why don’t you tell us about this phase 3 POSEIDON study that we’re hearing about for the first time? Heymach, MD, PhD: I bring that up because we’ll hear some differences with the POSEIDON study data. Heymach, MD, PhD: It’s 2 cycles of chemotherapy and then you’re done, but you do keep the ipilimumab going every 6 weeks. As you mentioned, this is only 2 cycles of chemotherapy, and you don’t keep the maintenance going with this regimen, right? Heymach, MD, PhD: Even though we think of patients with brain metastasis as the worst prognostic group, they did get greater relative benefit with this regimen. The hazard ratio was 0.36 for patients who got the combination regimen vs just chemotherapy, really encouraging for the immune checkpoint inhibitors in the brain. Also, that was regardless of whether patients had previously had radiation. It makes sense-nothing too novel there-but there are definitely some encouraging data. We’ve got the lymphocytes that are better at attacking the tumor that can get into the brain. It’s not that we’re trying to get those drugs directly into the brain. ![]() Sarah Goldberg at Yale School of Medicine did some of the first work a long time ago, but that’s been a consistent theme. We have a lot of data now with checkpoint inhibitors with brain activity. That was encouraging, showing that the combination checkpoint inhibitor plus chemotherapy was much better as far as reducing the likelihood of having brain metastases. But what they did talk about were the patients with brain metastases. The addition of a CTLA4 agent is probably more useful when we don’t have PD-L1 expression, but they didn’t go into that this time, so that’s a side note. We’re putting that into 1 of many regimens to be thinking about when we’re trying to figure out what to start with for our patients who don’t have tumors with driver mutations: 2 chemotherapy cycles vs 4, 2 immunotherapy drugs vs 1, when does it matter as much? When we look at the 2-year outcomes, they’re still looking better survival is 38% at 2 years, which isn’t bad at all. It’s a little different from some of our other regimens because it had a little less chemotherapy. CheckMate 9LA-if it doesn’t roll off your tongue all the time-was the combination of nivolumab and ipilimumab with chemotherapy but only 2 cycles of chemotherapy. Heather Wakelee, MD: We have a couple of updates, 1 focusing on patients with brain metastases and 1 looking at the 2-year follow-up. In light of that, Heather, tell us about the CheckMate 9LA regimen and the updates we have. Heymach, MD, PhD: Before we heard that 1 of the issues in the CheckMate 227 study is that there’s a population of patients who progress early, although a large group gets durable benefit. Atezolizumab for First-Line Treatment of PD-L1-Selected Patients with NSCLC. Herbst RS, Giaccone G, de Marinis F, et al. Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non-small-cell lung cancer (KEYNOTE-042): a randomised, open-label, controlled, phase 3 trial. Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Advances in Treatment of Locally Advanced or Metastatic Non-Small Cell Lung Cancer: Targeted Therapy. Non-Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment. ![]()
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