(069) Efficacy of Ipilimumab/Nivolumab vs Standard of Care Chemotherapy for Metastatic Non-Small Cell Lung Cancer Following Chemoimmunotherapy in the First Line Setting

Poster Abstract:

Background:
The landscape of non-small cell lung cancer (NSCLC) has rapidly changed with advances in immunotherapies and targeted therapies. Immune checkpoint inhibitors (ICIs) have a distinct mechanism in stimulating the host immune response to prevent cancer cells from evading destruction. Studies have shown the efficacy of combination chemoimmunotherapy in the front-line metastatic setting.

Immunotherapy in subsequent line settings is less clear as practical data in the second line setting after first line chemoimmunotherapy is lacking. Some data suggests that solid tumors may develop resistance to ICIs. Currently, guidelines do not recommend ICIs in the subsequent setting following chemoimmunotherapy. Without the use of ICIs in subsequent lines, treatment for NSCLC is limited. Consequently, providers may use dual ICI treatment, but there is no currently published data to support this practice. Results from this study will add to the literature regarding treatment options for metastatic NSCLC patients after progression on first line chemoimmunotherapy.

Objective:
The objective of this study is to evaluate the efficacy of dual immunotherapy compared to standard of care (SOC) chemotherapy after first line chemoimmunotherapy in metastatic NSCLC.

Methods:
In this retrospective chart review, dispensing records were obtained from May 1, 2017 through October 1, 2023 of ipilimumab and nivolumab and select SOC chemotherapies (docetaxel/ramucirumab, docetaxel, gemcitabine, vinorelbine, pemetrexed, and nab-paclitaxel). Patients were included if they received chemoimmunotherapy in the first line metastatic setting and received one of the regimens of interest in the second line setting. Patients were excluded if they participated in a clinical trial in the metastatic setting or received therapy for known targetable mutations. The primary objectives were objective response rate, progression free survival, and overall survival. Secondary objectives stratified patients according to histology and PD-L1 expression. Safety objectives included incidence of immune related adverse events in the immunotherapy arm. Continuous variables will be analyzed by summary statistics and categorical variables by frequency distributions. Simple linear and logistic and the Cox univariable and multi-variables regression analyses will be performed. Survival curves will be generated using Kaplan-Meier curves.

Results:
A total of 465 patients were screened, but few patients met inclusion criteria, with 26 patients included in the ipilimumab and nivolumab arm and 14 patients in the SOC arm. The most common reason for exclusion was not receiving the regimens of interest in the second line setting. Final results to be presented at HOPA Annual Conference.

Conclusions:
Final conclusions to be presented at HOPA Annual Conference.

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