Naval G. Daver, MD, discusses the rationale of azacitidine and nivolumab in acute myeloid leukemia.
Naval G. Daver, MD, associate professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses the rationale of azacitidine and nivolumab (Opdivo) in acute myeloid leukemia (AML).
In the first stage of a phase Ib/II study combined azacitidine and nivolumab. The study then moved on to utilize a combination of azacytidine and nivolumab with Ipilimumab (Yervoy). This study was designed based on immune profiling that was performed on 100 patients at The University of Texas MD Anderson Cancer Center. Researchers noticed that both newly diagnosed and relapsed AML had PD-1 expression. In a subset of patients, about 30% to 40% had high PD-L1 expression on their T cells, said Daver.
In the relapsed setting, the degree of PD-L1 expression on the T cells was increasing as the cells become more exhausted from subsequent relapses and the tumor environment becomes more immunosuppressive. Based on these findings, researchers postulated that introducing a PD-1 inhibitor in the relapsed setting of AML could reverse the T-cell exhaustion and improve response rates, concludes Daver.