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NSCLC (TEIL 1)
IMMUNONKOLOGIE (I-O) MITTELS CHECKPOINTINHIBITION: REVOLUTION DER NSCLC-THERAPIE?
Wichtige Mediatoren der Immunabwehr
Angeboren
Antigen unabhängig
Antigenpräsentierende
Zellen
DC
Adaptiv
Antigen abhängig
Lymphokine
TLR*
PRR*
NKG2D
IL´e
IFN´e
CK´e
...
Adaptiert nach Woelfel et al, 2014
KIR
T-Zellen
Fc
„natürliche
Killer-Zellen“
NK
B-Zellen
Fab
T
Fab
CTLA-4
CD28
TCR
IFN-g
Perforin
Granzym B
Wichtige Mediatoren der Immunabwehr
Angeboren
Antigen unabhängig
Antigenpräsentierende
Zellen
DC
Adaptiv
Antigen abhängig
Lymphokine
TLR*
PRR*
NKG2D
IL´e
IFN´e
CK´e
...
Adaptiert nach Woelfel et al, 2014
KIR
T-Zellen
Fc
„natürliche
Killer-Zellen“
NK
B-Zellen
Fab
T
Fab
Anpassungsfähigkeit
Spezifität
CTLA-4 Gedächtnis
CD28
TCR
IFN-g
Perforin
Granzym B
Die T-Zell-vermittelte antitumorale Immunantwort
2
1
Präsentation von Tumorantigen
gegenüber der T-Zelle
Tumor:
Freisetzung von
Tumorantigenen
3
4
Erkennung von
Tumorantigen
durch T-Zellen
5
Zerstörung
des Tumors
durch T-Zellen
Andersen et al, J Invest Dermatol 2006, 126: 32; Pardoll DM, Nat Rev Cancer 2012, 11: 252; Mellman et al,
Nature 2011, 480: 480; Heemskerk et al, EMBO J 2013, 32: 194; Boudreau et al, Mol Ther 2011, 19: 841;
Janeway et al, Immunobiology: The Immune System in Health and Disease. 6th ed, 2004.
T-Zell-Aktivierung
und Proliferation
Immunsystem und Krebs:
Der Prozess des Immunoediting
Die drei “E” des Immunoediting beschreiben die Prozesse der Tumorkontrolle
durch das Immunsystem und wie der Tumor dieser Kontrolle entkommt.
Elimination
Tumor-Immunüberwachung
CD8+
T-Zelle
CD4+
T-Zelle
Equilibrium
Escape
Tumor-Ruhezustand
(“Survival of the fittest”)
Tumor-Wachstum
NK
Zelle
Treg
Tumorzellen
Normale
Zellen
Vesely et al, Ann Rev Immunol 2011, 29: 235
Immune Escape-Mechanismen: Tumore nutzen komplexe
Mechanismen, dem Immunsystem zu entkommen
A. Ineffektive Tumor-AntigenPräsentation (gp100, MART-1,
verringerte MHC-Expression)
CD8+
TZelle
TCR
VEGF
APC
B. Rekrutierung immunsuppressiver Zellen
(regulatorische T-Zellen
=Tregs, MDSCs, andere)
MHC
CTLA-4
MDSC
Treg
PD-L1
Tumorzellen
PD-1
PD-L1
PD-1
TGF-β
IDO
IL-10
TGF-β
ARG1
iNOS
TGF-β
IL-10
CD4+
D. T-Zell-Checkpoints
Vesely et al, Ann Rev Immunol 2011, 29: 235
TZelle
CD8+
TZelle
C. Sekretion von immunsuppressiven Signalen
(z.B. PD-L1, TGF-β, IL-10,
und indolamine 2,3dioxygenase [IDO])
Die Immunonkologie mittels Checkpoint-Modifikation als
neues therapeutisches Behandlungskonzept1
•
•
Die konventionellen onkologischen Ansätze sind direkt gegen den Tumor
gerichtet.2
Bei der Immunonkologie wird die natürliche Fähigkeit des eigenen
Immunsystems genutzt, um den Krebs zu bekämpfen.2
Operation
Immunonkologie
Strahlentherapie
Chemo- &
zielgerichtete
Therapien
1. DeVita and Rosenberg, N Eng J Med 2012, 366: 2207; 2. Borghaei et al, Eur J Pharmacol 2009, 625: 41.
Regulation der T-Zell-Aktivität: Checkpoint-Moleküle
Aktivierende
Rezeptoren
Inhibierende
Rezeptoren
CTLA-4
CD28
PD-1
OX40
TIM-3
CD137
LAG-3
Aktivierung
Immunsystem
Adapted from Mellman I, et al. Nature. 2011:480;481–489; Pardoll DM. Nat Rev Cancer. 2012;12:252–264.
Neues Therapeutisches Konzept:
Blockade der CTLA-4- und PD-1-Checkpoint-Signalwege
Mikroumgebung des Tumors
Lymphknoten
Aktivierung
(Zytokine, Lyse, Proliferation,
Migration zum Tumor)
MHC
TCR
TCR
Dendritische B7 CD28
Zelle
B7 CTLA-4
+++
+++
+++ T-Zelle
---
Anti-CTLA-4
MHC
T-Zelle
PD-1
PD-L1
---
Tumorzelle
Anti-PD-1/PD-L1
PD-1
PD-L2
--Anti-PD-1
CTLA-4-Signalweg
CTLA-4 reguliert die Amplitude der frühen
Aktivierung von naiven und Memory T-Zellen.
Wolchock et al, J Clin Oncol 2013 ASCO Annual Meeting Abstracts 31:15_suppl
PD-1-Signalweg
PD-1 begrenzt die T-Zell-Aktivierung in der
Peripherie während einer Entzündungsreaktion.
Die Immunonkologie: Proof of Concept
Langzeitdaten Ipilimumab von 1.861 Melanompatienten
(8 Ph. II-, 2 Ph. III-, 2 Ph. IV-Studien)
Wahrscheinlichkeit Gesamtüberleben
•
1.0
0.9
0.8
0.7
Medianes OS, Monate (95% KI): 11,4 (10,7–12,1)
3-Jahres OS-Rate, % (95% KI): 22 (20–24)
0.6
0.5
0.4
0.3
0.2
0.1
Ipilimumab
Zensiert
0.0
0
12
24
36
48
60
72
84
96
108
120
120
26
15
5
0
Monate
Patienten unter Progressionsrisiko
Ipilimumab 1.861
839
370
254
192
170
Schadendorf et al, annual presentation at ECCO/ESMO 2013, abstract # 24LBA
Die Immunonkologie und „Hallmarks of Cancer“
Adapted from Hanahan et al, Cell 2011; 44: 646
Immuntherapeutische Ansätze am Beispiel Lungenkrebs
Immuntherapie
Passiv (adoptiv)
Aktiv
Zielt auf den Tumor;
Immun-basierter Mechanismus
Zielt auf das Immunsystem direkt
Antigenabhängig
Antigenunabhängig
Verstärkt die
Funktion der
Immunzelle
Therapeutische
Vakzine
Moduliert die TZell Funktion
Zytokine
GSK1572932A
TG4010
Belagenpumatucel-L
Tergenpumatucel-L
Racotumomab
Stimuvax
CIMAvax
Antitumorale
monoklonale
Antikörper
Adoptiv
Bavituximab
EGFR Inhibition
Adoptiver
Zelltransfer
Immun-Onkologie
(I-O)
CTLA-4-Inhibition
PD-1-Inhibition
PD-L1-Inhibition
CTLA-4 = cytotoxic T-lymphocyte antigen-4; PD-1 = programmed death-1; PD-L1 = programmed death ligand-1
www.clinicaltrials.gov accessed 26 March 2014; NCCN Guidelines ®. NSCLC. V2.2013; Peters et al. Ann Oncol.
2012;23:vii56
Klinische Entwicklung:
Immun-Checkpoint-Inhibitoren – PD-1-/PD-L1-Signalweg
Target
Antibody
a
Nivolumab
(BMS-936558)
PD-1
Pembrolizumab
(MK-3475)
Pidilizumab
(CT-011)
MEDI-4736
PD-L1
MPDL3280A
MSB0010718C
Development Stage
Phase 1-3: multiple tumors (melanoma, RCC,
NSCLC, HNSCC, GBM, Hodgkin, others)
Phase 1/2: multiple tumors
Phase 3: NSCLC
Approved: melanoma
Phase 1/2: multiple tumors
Phase 1/2: multiple tumors
Phase 2: CRC, HNSCC
Phase 3: NSCLC
Phase 1/2: multiple tumors
Phase 2: RCC, bladder
Phase 3: NSCLC
Phase 1/2: multiple tumors
CRC = colorectal cancer; GBM = glioblastoma multiforme; HNSCC = head and neck squamous cell carcinoma;
RCC = renal cell carcinoma
a List incomplete
www.clinicaltrials.gov. Accessed March 25, 2015.
Phase I-Studie Nivolumab Monotherapie:
Design der NSCLC-Kohorte (CA209-003)
• Phase 1 study of the safety, antitumor activity,
and pharmacodynamics of nivolumab in patients
with advanced solid tumors1
• Nivolumab 0,1 to 10 mg/kg
Q2W for a maximum of twelve
8-week treatment cycles
(2 years); expansion cohorts
for select tumor types2
• 1–5 previous therapies1
• In the 129 patients with
NSCLC
– 42% had squamous and
57% had non-squamous histology
– 54% received ≥3 prior therapies2
IV = intravenous; Q2W = every 2 weeks.
1. Topalian SL, et al. N Engl J Med. 2012;366:2443-2454.
2. Brahmer JR, et al. Presented at ASCO 2013. Abstract 8030.
Nivolumab
1 mg/kg IV Q2W
(n=33)
Eligible patients
with NSCLC
randomized
between
3 nivolumab
dose levels
Nivolumab
3 mg/kg IV Q2W
(n=37)
(n=129)
Nivolumab
10 mg/kg IV Q2W
(n=59)
Der anti-PD-1-AK Nivolumab bei fortgeschrittenen
Tumorerkrankungen: Phase I – CA209-003
Tumor
Type
NSCLC
Squamous
Nonsquamous
MEL
RCC
ORR n/N (%)
[95% CI]
22/129 (17,1)
[11,0, 24,7]
9/54 (16,7)
[17,9, 29,3]
Median Duration of
Response,
wk (range)
74,0
(6,1+, 133,9+)
NR
(16,1, 133,9+)
Stable Disease,
n/N (%) [95% CI]
≥ 24 wk
13/129 (10,1)
[5,5, 16,6]
8/54 (14,8)
[6,6, 27,1]
Median PFS,
mo [95% CI]
2,3
[1,9, 3,7]
3,7
[1,8, 7,2]
13/74 (17,6)
[9,7, 28,2]
63,9
(6,1+, 74,0+)
5/74 (6,8)
[2,2, 15,1]
2,0
[1,8, 3,6]
33/107 (30,8)
[22,3, 40,5]
10/34 (29,4)
[15,1, 47,5]
104,0
(18,4, 117,0+)
56,1
(36,6, 126,7+)
7/107 (6,5)
[2,7, 13,0]
9/34 (126,5)
[12,9, 44,4]
3,7
[1,9, 9,1]
7,3
[3,7, 12,9]
Hodi et al, Poster presentation at ECC 2013:abstract 880
Nivolumab beim fortgeschrittenen NSCLC: Überleben
Phase I CA209-003 (mehrfach vorbehandelte Patienten)
100
OS rate, % (95% CI)
90
Censored
80
70
Group
Died/Treated
1 mg/kg
3 mg/kg
10 mg/kg
99/129
23/37
50/59
Median OS, mo
(95% CI)
9,9 (7,8, 12,4)
14,9 (7,3,30,3)
9,2 (5,2,12,4)
1 Year
2 Years
3 Years
42 (33, 50)
56 (38,71)
38 (26, 50)
24 (17, 33)
42 (24,58)
20 (11, 31)
18 (11, 25)
27 (12, 43)
14 (7, 25)
OS (%)
60
50
2-year OS = 42%
40
3-year OS = 27%
30
20
10
0
0
3
6
9
12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66
Months Since Initiation of Treatment
Pts at Risk
Nivolumab 1 mg/kg
33
26
21
16
9
7
6
6
4
4
4
3
1
1
0
0
0
0
0
0
0
0
0
Nivolumab 3 mg/kg
37
34
26
21
17
14
13
12
11
9
9
7
5
2
1
1
1
1
1
1
1
1
0
Nivolumab 10 mg/kg
59
51
35
29
22
16
14
12
11
10
9
9
6
4
2
2
2
1
1
0
0
0
0
Gettinger et al, CMSTO 2014
Der anti-PD-1-AK Pembrolizumab beim fortgeschrittenen
NSCLC: Phase I-Studie – Wirksamkeit
RECIST v1.1,
Independent Review
irRC, Investigator Review
Subgroup
n
ORR, n (%)
[95% CI]
Median PFS,
wk (95% CI)
n
ORR,* (%),
[95% CI]
Median PFS,
wk (95% CI)
Median OS,
wk (95% CI)
All
38
9 (24%)
[11%, 40%]
9,1
(8,3, 17,4)
33
7 (21%)
[9%, 39%]
9,7
(7,6, 17)
51
(14, NR)
Non-squamous
31
7 (23%)
[10%, 41%]
9,1
(8,3, 17,0)
26
4 (16%)
[4%, 35%]
10,3
(7,6, 17)
35
(14, NR)
Squamous
6
2 (33%)
[4%, 78%]
23,5
(2,7, NR)
6
2 (33%)
[4%, 78%]
15,2
(1,4, NR)
NR
(2,7, NR)
Patients with measurable disease on baseline imaging and an evaluable tumor specimen for PD-L1
Score ≥ potential
cut point
9
6 (67%)
[30%, 93%]
–
7
4 (57%)
[18%, 90%]
–
–
Score < potential
cut point
24
1 (4%)
[0%, 21%]
–
22
2 (9%)
[1%, 29%]
–
–
Garon et al, WCLC 2013, #2416
Einfluss der Histologie –
Wirksamkeit der Anti-PD-1-/PD-L1-Antikörper
Nivolumab
MPDL3280A
Squamous
NS
S
NS
NS
NS
S
Nonsquamous
NS
On study, on treatment
S
0
16
32
48
64
80
96
Time (week)
On study, post treatment
Duration of response
on study
NS
Treatment discontinued
Ongoing
response
NS
Ongoing response
Time to response
NS
First response
Response duration
after discontinuation
NS
First PD
112
128
144
160
0
6
12
18
24
30
36 42
48
Time (weeks)
Adapted from Brahmer JR, et al. Mini-Oral presentation at WCLC 2013. J Thorac Oncol. 2013;8(Suppl 2):abstract:
MO18.03; Horn L, et al. Mini-Oral presentation at WCLC 2013. J Thorac Oncol. 2013;8(Suppl 2):abstract: MO18.01.
54
60
66
72
78
KEYNOTE-001:
Geschätzte Überlebenskurve (Kaplan-Meier)
PFS (Recist v1.1, Central Review)
• Treatment naive
– Median PFS: 27 weeks (95% CI, 14–45)
– 24-week PFS: 51%
• Previously treated
– Median PFS: 10 weeks (9,1–15,3)
– 24-week PFS: 26%
Analysis cutoff date: March 3, 2014
Garon et al, Oral presentation at ESMO 2014
OS
• Treatment naive
– Median OS: NR (95% CI, NE-NE)
– 6-month OS: 86%
• Previously treated
– Median OS: 8,2 months (7,3 - NR)
– 6-month OS: 59%
Klinisches Ansprechen nach PD-L1-Immunohistochemie
Anti PD-1
MK-3475
ORR n/N (%)
All patients
21%
Anti PD-L1
Nivolumab
ORR n/N (%)
22/129 (17,1%)
MEDI4736
ORR n/N (%)
MPDL3280A
ORR n/N (%)
9/58 (16%)
12/53 (23%)
PD-L1 Status (evaluable pts.)
Positive
37/159 (23%)
5/31 (16%)
5/20 (25%)
8/26 (31%)
Negative
3/35 (9%)
4/32 (13%)
1/29 (3%)
4/20 (20%)
Offene Fragen
• Unterschiedliche Gewebsentnahmezeiten
• Unterschiedliche Antikörper und Assays
• Unterschiedliche IHC-Kriterien
Horn L, J Thorac Oncol 2013; 8 (Suppl 2), #MO18.01; Brahmer JR, J Thorac Oncol 2013; 8 (Suppl2), #MO1803;
Antonia SJ, J Thorac Oncol 2013 (Suppl 2), #P2 11-034; Garon E, ASCO 2014; #8020; Brahmer J, ASCO 2014,
#8021
Pembrolizumab – Phase I-Studie
100
90
80
70
60
50
40
30
20
10
0
Strong
Weak
Negative
0
n at risk
Strong
Weak
Negative
OS
8
16
24
32
40
Overall Survival, %
Progression-Free Survival, %
PFS (Recist v1.1, Central Review)
48
28
43
30
18
17
15
17
12
7
Strong
Weak
Negative
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14
Time, months
Time, weeks
44
53
49
100
90
80
70
60
50
40
30
20
10
0
9
6
1
6
0
0
3
0
0
44 43 38 38 34 32 30 27 21 18 9
53 51 48 40 34 31 26 22 18 11 8
49 42 38 34 29 26 21 14 8 6 4
8
7
2
5
5
0
5
5
0
• PFS was longer in patients with PD-L1 strong-positive versus PD-L1 weak-positive/ negative
tumors (HR, 0.52; 95% CI, 0.33-0.80)
• OS was longer in patients with PD-L1 strong-positive versus PD-L1 weak-positive/ negative
tumors (HR, 0.59; 95% CI, 0.35-0.99)
a Evaluable patients were those patients in the training set with evaluable tumor PD-L1 expression.
Strong PD-L1 positivity defined as staining in ≥50% of tumor cells, and weak PD-L1 positivity as staining in 1-49% of
tumor cells. Negative staining is no PD-L1 staining in tumor cells.
Analysis cutoff date: March 3, 2014; Garon et al, Oral presentation at ESMO 2014
4
4
0
Korrelation zwischen PD-L1-Status und klinischem
Outcome: Ein potentieller prädiktiver Biomarker?
Daten mit PD-1-Checkpoint-Inhibitoren
weisen darauf hin, dass die PD-L1Expression im Tumor signifikant mit einem
verbesserten Ansprechen und Überleben
assoziiert ist1…..
ABER
Patienten mit PD-L1-negativen Tumoren
sprechen auch auf die Therapie an2,3…
1. Garon EB, et al. Presented at ESMO 2014. Abstract LBA 43.
2. Gettinger SN, et al. Presented at CMSTO 2014. Poster 170.
3. Ramalingam S, et al. Presented at CMSTO 2014. Abstract 3462
NSCLC – Zulassungsrelevante Studien mit Nivolumab
STUDY
PRIMARY
ENDPOINT
STATUS
PUBLICATION
Nivolumab
ORR
ongoing
not recruiting
Rizvi N.A,,
Wolf J., Grohé C.,
Huber R.M., et al.
The Lancet Oncology
16.3 (2015): 257-265.
Allcomer
Nivolumab
vs. Docetaxel
OS
ongoing
not recruiting
2L+
Allcomer
Nivolumab
vs. Docetaxel
OS
ongoing
not recruiting
1L
PD-L1+
Nivolumab
vs. ICC
PFS
ongoing
not recruiting
LINE
ALLCOMER
PD-L1+
PHASE
POPULATION
CA209-063
2
NSCLC
squamous
3L+
Allcomer
CA209-017
3
NSCLC
squamous
2L
CA209-057
3
NSCLC
non-squamous
CA209-026
3
NSCLC
squamous
non-squamous
DESIGN
ORR = Objective Response Rate, OS = Overall Survival, PFS= Progression Free Survival,
ICC = Investigator's Choice Chemotherapy
www.clinicaltrials.gov
Nivolumab Phase II CA209-063: Studiendesign
Population
Stage IIIB/IV
NSCLC squamous
• ≥2 prior systemic
therapies
• ECOG 0–1
Treatment
Endpoints
Primary:
• Confirmed ORR
(IRC assessed)
Nivolumab
3 mg/kg IV Q2W*
n=117
Secondary:
• Confirmed ORR
(investigator assessed)
Exploratory:
• Safety and tolerability
• PFS/OS
• PD-L1 expression and efficacy
Title:
Study of Nivolumab (BMS-936558) in Subjects With Advanced or Metastatic
Squamous Cell Non-Small Cell Lung Cancer Who Have Received At Least
Two Prior Systemic Regimens (CheckMate 063)
ORR = Objective Response Rate, IRRC = Independent Radiology Review Committee OS = Overall Survival, PFS=
Progression Free Survival
* until disease progression, discontinuation due to toxicity, withdrawal of consent or the study ends
www.clinicaltrials.gov
CA209-063: Ansprechen und Überleben
(Größte Reduktion der Targetläsion)a
Best Reduction from Baseline
in Target Lesion (%)
100
Alive
Expired
Confirmed responders
75
50
25
0
-25
-50
-75
n=95 response-evaluable
-100
Patient
• 8 confirmed PRs in patients with rapid progression on prior therapy
• Among all treated patients; 13% continuing treatment and 24% received
subsequent therapy
– Most frequent therapies were gemcitabine (10%), docetaxel (4%), and vinorelbine (4%)
– No patients received subsequent immunotherapy
a Based on July 2014 DBL; 22/117 treated patients are not displayed due to lack of evaluable on-study assessments;
18/22 expired; Dashed horizontal reference line indicates the 30% reduction consistent with a RECIST v1.1
response; Ramalingam et al. CMSTO 2014
CA209-063: Klinische Aktivität von Nivolumab
Nivolumab 3 mg/kg
ORR, % (n) [95% CI]
Disease control rate, % (n)
Median DOR, months (range)
IRC Assessed (per RECIST v1.1)a
15 (17) [9, 22]
40 (47)
NR (2+, 12+)
Ongoing responders, % (n)
76 (13)
Median time to response, months (range)
3 (2, 9)
PFS rate at 1-year, % (95% CI)
20 (13, 29)
Median PFS, months (95% CI)
2 (2, 3)
• Investigator-assessed ORR was 13% (95% CI, 7, 20)
– Concordance between IRC and investigator assessed responders was 92%
(based on March 2014 DBL)
a July 2014 DBL
NR = not reached; DOR = duration of response; ORR = objective response rate; PFS = progression free survival
Ramalingam et al. CMSTO 2014
CA209-063: Ansprechmustera
Percent Change in Baseline (%)
100
1st Occurrence of new lesion
PR
Patients still on treatment
75
50
25
0
-25
-50
-75
-100
0
6
12
18
25
30
36
42
48
54
60
Time Since First Treatment (Weeks)
• 4 patients with non-conventional responses not reported as IRC-assessed
responders
– 3 alive (OS: 12+, 13+, 14+ months)
a Based on July 2014 DBL
Ramalingam et al. CMSTO 2014
66
CA209-063: Gesamtüberleben (OS): Alle behandelten
Patientena
Overall Survival (%)
100
Median OS, months (95% CI)
8,2 (6, 11)
90
1-year OS rate, % (95% CI)
41 (32, 50)
80
Number of events
72/117
70
Median OS = 8,2 months
60
50
1-year OS = 41%
40
30
20
10
0
0
Number of Patients at Risk
Nivolumab
117
3mg/kg
•
3
6
9
12
15
18
28
5
0
Overall Survival (Months)
93
68
51
Median follow-up for survival: 8 months (range 0–17 months)
a Based on July 2014 DBL; Symbols represent censored observations
Ramalingam et al. CMSTO 2014
CA209-063: Therapiebedingte
unerwünschte Ereignisse in ≥10% der Patientena
Nivolumab 3 mg/kg (n = 117)
Any Grade
Grade 3–4
74
17
Fatigue
33
4
Decreased appetite
19
0
Nausea
15
0
Asthenia
12
0
Rash
11
1
Diarrhea
10
3
Total patients with an event,b %
•
•
•
•
85% of patients received at least 90% of their planned dose intensity
12% discontinued treatment due to study drug toxicity (4% pneumonitis)
Grade 3 treatment-related pneumonitis was reported in 4 patients (3%); one
additional grade 3 case occurred between 30–100 days after last nivolumab dose
62% had expired at time of analysis (54% PD and 2% study drug toxicity)
– Two treatment-related deaths (1 hypoxic pneumonia and 1 ischemic stroke) occurred
in patients with multiple comorbidities and concurrent PD
a July 2014 DBL; b Includes events reported between first dose and 30 days after last dose of study therapy. Of the
adverse events included in the table, no events were grade 5
Ramalingam et al. CMSTO 2014
Studiendesign: CA209-017 und CA209-057
Phase 3
CA209-017
Stage IIIb/IV
squamous cell NSCLC
2L
Phase 3
CA209-057
www.clinicaltrials.gov
Stage IIIb/IV
nonsquamous cell NSCLC
2/3L
Nivolumab
3 mg/kg IV q2w
OS
Docetaxel
75 mg/m2 IV q3w
OS
Nivolumab
3 mg/kg IV q2w
OS
Docetaxel
75 mg/m2 IV q3w
OS
http://www.bms.com/news/press_releases/pages/default.aspx
Fazit: PD-1-Inhibition beim NSCLC
•
Immun-Checkpoint-Inhibitoren zeigen ermutigende Ergebnisse in klinischen Studien
(Phase 1-3)
•
Eindrucksvolles Ansprechen und Überleben bei vorbehandelten Patienten mit Adeno- und
Plattenepithelkarzinomen
•
Ein Teil der Patienten zeigt möglicherweise ein Langzeitüberleben
•
Toxizität mäßig und beherrschbar
•
Mehrere Substanzen in klinischer Entwicklung
•
PD-L1 erster prädiktiver Biomarker, aber auch PD-L1-negative
Patienten profitieren
•
Ausblick: Optimierung durch Kombinationstherapien
Die Immunonkologie als fest verankertes
Behandlungskonzept in der Onkologie
Operation
Immunonkologie
Strahlentherapie
Chemo- &
zielgerichtete
Therapien
DeVita et al, N Eng J Med 2012; 366: 2207; Borghaei et al, Eur J Pharmacol 2009; 625: 41
Stand: April 2015
Bitte beachten Sie, dass sehr bald neue Daten und
Updates der hier vorgestellten Studien folgen!