Dr. West on the Use of Nivolumab/Ipilimumab in Metastatic NSCLC

Howard (Jack) West, MD, executive director of Employer Strategy and associate clinical professor of the Department of Medical Oncology & Therapeutics Research, discusses the use of nivolumab (Opdivo) in combination with ipilimumab (Yervoy) in metastatic non–small cell lung cancer (NSCLC).

The combination has been utilized in this disease for several years; however, within the past 18 months, nivolumab/ipilimumab has demonstrated an overall survival benefit in this patient population, according to West. This benefit extends to patients who have PD-L1 positivity and those who do not, as well as in those with squamous or nonsquamous histology, West adds.

The phase 3 CheckMate-227 trial led to the May 2020 FDA approval of nivolumab/ipilimumab in the treatment of patients with metastatic NSCLC without EGFR or ALK genomic tumor aberrations, and whose tumors express a PD-L1 level of 1% or greater. In this trial, the comparator was single-agent chemotherapy, an older standard of care that has since been replaced, says West. In some ways, this is a lateral progression due to pembrolizumab (Keytruda) having shown superiority to single-agent chemotherapy in the phase 3 KEYNOTE-024 and KEYNOTE-042 trials, in which the agent showed benefit in the PD-L1–high population, West concludes.