The survival benefits of nivolumab plus ipilimumab over chemotherapy in metastatic NSCLC irrespective of tumour PD-L1 status have been reaffirmed in latest 6-year follow-up data from the CheckMate 227 study.

The data, presented at the International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer 2023 in Singapore, follows publication earlier this year of the 5-year follow-up.

Published in the Journal of Clinical Oncology [link here], this 5-year data found overall survival (OS) rates were 24% versus 14% for nivolumab plus ipilimumab versus chemotherapy in PD-L1 ≥ 1% patients and 19% versus 7% in PD-L1 < 1% patients.

Median duration of response was 24.5 versus 6.7 months in PD-L1 ≥ 1% patients and 19.4 versus 4.8 months PD-L1 < 1% patients.

The study also found quality of life in 5-year survivors treated with the immunotherapy combination was similar to that in the general US population throughout the follow-up.

Presenting the latest data at IALSC, oncologist Professor Solange Peters from the Lausanne University Hospital in Switzerland, said the six-year OS rates were 22% versus 13% for patients with tumor PD-L1 ≥1% and 16% versus 5% for PD-L1 <1%.

Similarly, 6-year progression free-survival (PFS) was 11% with immunotherapy compared to 2% with chemotherapy in PD-L1 ≥ 1% patients and 8% versus non-at risk (NA) in the PD-L1 <1%.

Professor Peters told the IALSC press conference that the duration of response was 27% versus 4% in PD-L1 ≥ 1% patients and 25% versus NA in PD-L1 <1% patients.

“Remember that all of these patients have stopped the treatment at two years,” she said.

“This data represents the longest reported follow-up across all phase 3 trials of non-small cell lung cancer using immunotherapy and the clinical benefit is further highlighted …regardless of the level of PD-L1.”

She said it was perhaps not surprising that the magnitude of burden reduction in tumour lesions from baseline correlated with patient survival.

“And that’s something which for me indicates to the clinician how those things are moving over time, helping to support treatment decisions in the future,” she said.

“So all of these deeper responses were associated with long term benefit and it was of course, regardless of the PD-L1 expression.”

Professor Peters also said the safety profile of combination immunotherapy was unchanged from previous reports, tolerable and generally manageable.

Baseline health-related quality of life was associated with improved overall survival in both the immunotherapy and chemotherapy arms, she added.

“It might be a little intuitive, but sometimes it helps in making treatment decisions to know where you start from with the patients.”