Nivolumab shows good efficacy in patients with advanced gastric cancer

The recent ONO-4538-12 clinical study released at the ASCO-GI conference showed that compared with placebo, Nivolumab reduced the risk of death of patients by 37%, and the overall 12-month survival rate of patients treated with Nivolumab reached 26.6%. The 12-month overall survival rate of placebo-administered patients was only 10.9%.

On January 19, 2017, Bristol-Myers Squibb announced the results of a clinical study called ONO-4538-12, which showed that Nivolumab significantly reduced the risk of death in patients with advanced gastric cancer who were ineffective or intolerant to standard treatment 37% (HR0.63; p <0.0001), and there is currently no standard treatment for such patients. The ONO-4538-12 study is a phase III randomized, double-blind, placebo-controlled clinical study evaluating the efficacy and safety of Nivolumab in such patients. The primary endpoint of the study was overall survival (OS). The median OS in the Nivolumab group and the placebo group were 5.32 months (95% CI: 4.63-6.41) and 4.14 months (95% CI: 3.42-4.86) (p <0.0001). The 12-month overall survival rates of the Nivolumab group and the placebo group were 26.6% (95% CI: 21.1-32.4) and 10.9% (95% CI: 6.2-17.0), respectively. After the patient was treated with Nivolumab, the secondary endpoint objective response rate reached 11.2% (95% CI: 7.7-15.6), and the median duration of response was 9.53 months (95% CI: 6.14-9.82). The objective response rate in the placebo group was 0% (95% CI: 0.0-2.8).

Nivolumab’s safety is consistent with previous reports of solid tumor studies. In the Nivolumab group and placebo group, the incidence of all treatment-related adverse events (TRAE) was 42.7% and 26.7%, and the incidence of grade 3/4 TRAE was 10.3% and 4.3%, respectively. Grade 3/4 TRAEs occurred in more than 2% of patients in the Nivolumab group including diarrhea, fatigue, decreased appetite, fever, and increased AST and ALT. Grade 3/4 TRAEs occurred in more than 2% of patients in the placebo group were fatigue and decreased appetite . In the Nivolumab group and the placebo group, the incidence of discontinuation TRAE was similar, 2.7% and 2.5%, respectively.

ONO-4538-12 research data was announced in the breakthrough oral report of the 2017 Gastrointestinal Oncology Symposium (ASCOGI) in San Francisco, California, USA, from 2:00 to 3:30 pm on January 19 (Abstract No. 2 ).

The ONO-4538-12 study is the first phase III randomized clinical trial of tumor immunotherapy that improves the survival rate of patients with advanced or relapsed gastric cancer . We think the results of Nivolumab treatment are encouraging because gastric cancer is the cause of cancer deaths worldwide At the forefront of this, there is a huge unmet need in patients with advanced gastric cancer who are intolerant to chemotherapy or who have failed chemotherapy, “said Ian M. Waxman, MD, head of research and development at Bristol-Myers Squibb Gastrointestinal Cancer.

“These results confirm the clinical benefit of Nivolumab in the treatment of advanced or recurrent gastric cancer, and provide a strong basis for the further research of Nivolumab for gastric cancer treatment,” the chief clinical investigator, Seoul Asian Medical Center, Ulsan University, South Korea Yoon-KooKang, MD and MD of the Medical College of Oncology, commented.

The ONO-4538-12 study (NCT02267343) is a phase III, randomized, double-blind, placebo-controlled clinical study conducted in Japan, South Korea, and Taiwan. It evaluated the unresectability (cannot be removed by surgery) and standard of Nivolumab Therapeutic treatment is ineffective or intolerant in the treatment of patients with advanced or recurrent gastric cancer (including gastroesophageal junction cancer) in patients with efficacy and safety. The clinical study was conducted by Japan’s Ono Pharmaceutical Co., Ltd., a Bristol-Myers Squibb Nivolumab R & D partner.

In the ONO-4538-12 study, patients received nivolumab 3 mg / kg or placebo once every two weeks until the tumor progressed or discontinued due to intolerable toxicity. The primary endpoint OS was evaluated for effectiveness relative to placebo. Secondary endpoints included objective response rate, duration of response, progression-free survival, optimal total response rate, time to tumor response, disease control rate, and safety-related variables.

NIVOLUMAB indication approved by the US Food and Drug Administration (FDA)

Nivolumab monotherapy can be used to treat BRAFV600 mutation-positive unresectable or metastatic melanoma . Based on the significant effect of Nivolumab on progression-free survival, the indication was quickly approved. According to the clinical benefit results of the confirmatory test, the continued approval of the indication can be judged.

Nivolumab monotherapy can be used to treat BRAFV600 wild-type unresectable or metastatic melanoma.

Nivolumab combined with Ipilimumab is suitable for the treatment of patients with unresectable or metastatic melanoma. Based on the remarkable effect of the therapy on progression-free survival, the indication was quickly approved. The continued approval of the indication will be judged based on the clinical benefit results of the confirmatory test.

Nivolumab can be used to treat metastatic non-small cell lung cancer (NSCLC) that progresses during or after platinum-based chemotherapy regimens. For patients with EGFR mutations or ALK rearrangements, before using Nivolumab, it should be confirmed that the patients have used FDA-approved therapeutic drugs for these genetic abnormalities and disease progression has occurred.

Nivolumab can be used to treat patients with advanced renal cell carcinoma (RCC) who have used anti-angiogenic drugs.

Nivolumab can be used for autologous hematopoietic stem cell transplantation (HSCT) and after transplantation, brentuximabvedotin is used to treat recurrent or progressive classic Hodgkin lymphoma (cHL). Based on the drug’s significant effect on the overall response rate, the indication was approved quickly. The continued approval of the indication will be judged based on the clinical benefit results of the confirmatory test.