For patients with mNSCLC (PD-L1 ≥1%)

OPDIVO® + YERVOY® was assessed in a landmark phase 3 study that included patients regardless of histology1

Part 1a study design1,2

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) combination therapy checkmate 227 part 1a clinical trial design with key eligibility criteria, stratification, dosing, treatment, and primary and secondary endpoints.

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) combination therapy checkmate 227 part 1a clinical trial design with key eligibility criteria, stratification, dosing, treatment, and primary and secondary endpoints.

  • Patients with untreated brain metastases, carcinomatous meningitis, active autoimmune disease, or medical conditions requiring systemic immunosuppression were excluded1
  • Tumor specimens were evaluated prospectively using the PD-L1 IHC 28-8 pharmDx assay at a central laboratory.1

*In Checkmate 227, patients in the comparator arm received up to 4 cycles of platinum-doublet chemo q3w; NSQ: pemetrexed + carboplatin or cisplatin, with optional pemetrexed maintenance following chemo; SQ: gemcitabine + carboplatin or cisplatin.1,2,4

ALK=anaplastic lymphoma kinase; DOR=duration of response; ECOG PS=Eastern Cooperative Oncology Group Performance Status; EGFR=epidermal growth factor receptor; IHC=immunohistochemistry; I-O=immuno-oncology; mNSCLC=metastatic non-small cell lung cancer; NSCLC=non-small cell lung cancer; NSQ=non-squamous; ORR=overall response rate; OS=overall survival; PD-L1=programmed death-ligand 1; PFS=progression-free survival; q2w=every 2 weeks; q3w=every 3 weeks; q6w=every 6 weeks; SQ=squamous.


In a cross-histology trial for patients with mNSCLC (PD-L1 ≥1%)

Durable survival with OPDIVO + YERVOY: 29% of patients alive at 4 years3

OS for PD-L1 ≥1% (extended follow-up analysis)2,3

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) Combination Therapy - Primary Analysis OS in patients with PD-L1≥1%

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) Combination Therapy - Primary Analysis OS in patients with PD-L1≥1%

Median follow-up of 54.8 months.3

  • Median PFS with a median follow-up of 54.8 months: 5.1 months (95% CI: 4.1–6.3) with OPDIVO + YERVOY and 5.6 months (95% CI: 4.6–5.8) with chemo alone; HR=0.81; 95% CI: 0.68–⁠0.961,3
  • 29% of patients enrolled had SQ disease; 71% had NSQ disease1

CI=confidence interval; HR=hazard ratio; mo=month.

vs chemo. In Checkmate 227, patients in the comparator arm received up to 4 cycles of platinum-doublet chemo q3w; NSQ: pemetrexed + carboplatin or cisplatin, with optional pemetrexed maintenance following chemo; SQ: gemcitabine + carboplatin or cisplatin.1,4

In Checkmate 227 Part 1a, PFS, ORR, and DOR were pre-specified descriptive analyses. The primary efficacy outcome measure was OS.1,2,4

Serious Adverse Reactions

In Checkmate 227, serious adverse reactions occurred in 58% of patients (n=576). The most frequent (≥2%) serious adverse reactions were pneumonia, diarrhea/colitis, pneumonitis, hepatitis, pulmonary embolism, adrenal insufficiency, and hypophysitis. Fatal adverse reactions occurred in 1.7% of patients; these included events of pneumonitis (4 patients), myocarditis, acute kidney injury, shock, hyperglycemia, multi-system organ failure, and renal failure.

Common Adverse Reactions

In Checkmate 227, the most common (≥20%) adverse reactions were fatigue (44%), rash (34%), decreased appetite (31%), musculoskeletal pain (27%), diarrhea/colitis (26%), dyspnea (26%), cough (23%), hepatitis (21%), nausea (21%), and pruritus (21%).

In a cross-histology trial for patients with mNSCLC (PD-L1 ≥1%)

OPDIVO + YERVOY: the only I-O combination with a mDOR of 23.2 months among responders1

  • ORR was 36% (144/396) with OPDIVO + YERVOY and 30% (120/397) with chemo1,12
  • 5.8% CR with OPDIVO + YERVOY and 1.8% with chemo4
  • 34% of responders to OPDIVO + YERVOY were still responding at 4 years and 7% of chemo responders were still responding to chemo3

mDOR and range (extended follow-up analysis)3

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) Combination Therapy - DOR in patients with PD-L1≥1%

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) Combination Therapy - DOR in patients with PD-L1≥1%

Median follow-up of 54.8 months.3

  • In Checkmate 227 Part 1a, PFS, ORR, and DOR were pre-specified descriptive analyses. The primary efficacy outcome measure was OS with a minimum follow-up of 29.3 months1,2,4
    • ORR: 36% (144/396, 95% CI: 32–41) CR=5.8%, PR=30.1% with OPDIVO + YERVOY and 30% (120/397, 95% CI: 26–35) CR=1.8%, PR=28.2% with chemo1,2,4
    • Median TTR was 2.0 months with OPDIVO + YERVOY and 1.6 months with chemo4

CR=complete response; mDOR=median duration of response; PR=partial response; TTR=time to response.

Among OPDIVO + YERVOY responders at 6 months, 70% alive at 3.5 years (post-randomization)

  • ORR was 36% (144/396) with OPDIVO + YERVOY and 30% (120/397) with chemo1,3,4
  • This is a post-hoc, exploratory, conditional landmark analysis where patients were grouped by response category based on assessment at 6 months5||
    • A conditional landmark analysis can minimize potential guarantee time bias when the time to response may be different between arms or when comparing responding patients and non-responding patients
    • No formal statistical testing was planned for this and, therefore, no statistical conclusions can be drawn
    • The 6-month time point was chosen because it is the earliest time point when most of the responses in each treatment arm had occurred
    • An important limitation of this analysis is that responding patients who died before 6 months were not included

OS (PD-L1 ≥1%) in responders (CR/PR) at 6 months
(post-hoc exploratory landmark analysis)5,6

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) Combination Therapy - OS in responders (CR/PR) at 6 months in patients with PD-L1≥1% (post-hoc exploratory landmark analysis)

OPDIVO® (nivolumab) + YERVOY® (ipilimumab) Combination Therapy - OS in responders (CR/PR) at 6 months in patients with PD-L1≥1% (post-hoc exploratory landmark analysis)

Minimum follow-up for post-landmark OS: 31.7 months.1

§Post-randomization: Time point measurement starting from treatment initiation (month 0).3

||Response categories based on information at 6 months are different from best overall response, which was based on all data from study follow-up.3

NR=not researched.

  • 6 month post-randomization was the landmark5
    • 1 year post-landmark was conducted at 18 months
    • 2 years post-landmark was conducted at 30 months
    • 3 years post-landmark was conducted at 42 months
  • In Checkmate 227 Part 1a, PFS, ORR, and DOR were pre-specified descriptive analyses. The primary efficacy outcome measure was OS1,4
  • ORR: 36% (144/396, 95% CI: 32–41) CR=5.8%, PR=30.1% with OPDIVO + YERVOY and 30% (120/397, 95% CI: 26–35) CR=1.8%, PR=28.2% with chemo1-4

For patients who are appropriate candidates for chemo, CliCK HERE

Indication

OPDIVO, in combination with YERVOY and 2 cycles of platinum-doublet chemotherapy, is indicated for the first-line treatment of adult patients with metastatic or recurrent non-small cell lung cancer (NSCLC), with no EGFR or ALK genomic tumor aberrations.1

SELECT IMPORTANT SAFETY INFORMATION

Severe and Fatal Immune-Mediated Adverse Reactions Immune-mediated adverse reactions listed herein may not include all possible severe and fatal immune-mediated adverse reactions.

Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue. While immune-mediated adverse reactions usually manifest during treatment, they can also occur after discontinuation of OPDIVO or YERVOY. Early identification and management are essential to ensure safe use of OPDIVO and YERVOY. Monitor for signs and symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate clinical chemistries including liver enzymes, creatinine, adrenocorticotropic hormone (ACTH) level, and thyroid function at baseline and periodically during treatment with OPDIVO and before each dose of YERVOY. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate.

Withhold or permanently discontinue OPDIVO and YERVOY depending on severity (please see section 2 Dosage and Administration in the accompanying Full Prescribing Information). In general, if OPDIVO or YERVOY interruption or discontinuation is required, administer systemic corticosteroid therapy (1 to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroid therapy. Toxicity management guidelines for adverse reactions that do not necessarily require systemic steroids (e.g., endocrinopathies and dermatologic reactions) are discussed below.

Immune-Mediated Pneumonitis
OPDIVO and YERVOY can cause immune-mediated pneumonitis. The incidence of pneumonitis is higher in patients who have received prior thoracic radiation. In NSCLC patients receiving OPDIVO 3 mg/kg every 2 weeks with YERVOY 1 mg/kg every 6 weeks, immune-mediated pneumonitis occurred in 9% (50/576) of patients, including Grade 4 (0.5%), Grade 3 (3.5%), and Grade 2 (4.0%). Four patients (0.7%) died due to pneumonitis.

Immune-Mediated Colitis
OPDIVO and YERVOY can cause immune-mediated colitis, which may be fatal. A common symptom included in the definition of colitis was diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies.

Immune-Mediated Hepatitis and Hepatotoxicity
OPDIVO and YERVOY can cause immune-mediated hepatitis.

Immune-Mediated Endocrinopathies
OPDIVO and YERVOY can cause primary or secondary adrenal insufficiency, immune-mediated hypophysitis, immune-mediated thyroid disorders, and Type 1 diabetes mellitus, which can present with diabetic ketoacidosis. Withhold OPDIVO and YERVOY depending on severity (please see section 2 Dosage and Administration in the accompanying Full Prescribing Information). For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated. Hypophysitis can present with acute symptoms associated with mass effect such as headache, photophobia, or visual field defects. Hypophysitis can cause hypopituitarism; initiate hormone replacement as clinically indicated. Thyroiditis can present with or without endocrinopathy. Hypothyroidism can follow hyperthyroidism; initiate hormone replacement or medical management as clinically indicated. Monitor patients for hyperglycemia or other signs and symptoms of diabetes; initiate treatment with insulin as clinically indicated.

Immune-Mediated Nephritis with Renal Dysfunction
OPDIVO and YERVOY can cause immune-mediated nephritis.

Immune-Mediated Dermatologic Adverse Reactions
OPDIVO can cause immune-mediated rash or dermatitis. Exfoliative dermatitis, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS) has occurred with PD-1/PD-L1 blocking antibodies. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate nonexfoliative rashes.

YERVOY can cause immune-mediated rash or dermatitis, including bullous and exfoliative dermatitis, SJS, TEN, and DRESS. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-bullous/exfoliative rashes.

Withhold or permanently discontinue OPDIVO and YERVOY depending on severity (please see section 2 Dosage and Administration in the accompanying Full Prescribing Information).

Other Immune-Mediated Adverse Reactions
The following clinically significant immune-mediated adverse reactions occurred at an incidence of <1% (unless otherwise noted) in patients who received OPDIVO monotherapy or OPDIVO in combination with YERVOY or were reported with the use of other PD-1/PD-L1 blocking antibodies. Severe or fatal cases have been reported for some of these adverse reactions: cardiac/vascular: myocarditis, pericarditis, vasculitis; nervous system: meningitis, encephalitis, myelitis and demyelination, myasthenic syndrome/myasthenia gravis (including exacerbation), Guillain-Barré syndrome, nerve paresis, autoimmune neuropathy; ocular: uveitis, iritis, and other ocular inflammatory toxicities can occur; gastrointestinal: pancreatitis to include increases in serum amylase and lipase levels, gastritis, duodenitis; musculoskeletal and connective tissue: myositis/polymyositis, rhabdomyolysis, and associated sequelae including renal failure, arthritis, polymyalgia rheumatica; endocrine: hypoparathyroidism; other (hematologic/immune): hemolytic anemia, aplastic anemia, hemophagocytic lymphohistiocytosis (HLH), systemic inflammatory response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), sarcoidosis, immune thrombocytopenic purpura, solid organ transplant rejection.

In addition to the immune-mediated adverse reactions listed above, across clinical trials of YERVOY monotherapy or in combination with OPDIVO, the following clinically significant immune-mediated adverse reactions, some with fatal outcome, occurred in <1% of patients unless otherwise specified: nervous system: autoimmune neuropathy (2%), myasthenic syndrome/myasthenia gravis, motor dysfunction; cardiovascular: angiopathy, temporal arteritis; ocular: blepharitis, episcleritis, orbital myositis, scleritis; gastrointestinal: pancreatitis (1.3%); other (hematologic/immune): conjunctivitis, cytopenias (2.5%), eosinophilia (2.1%), erythema multiforme, hypersensitivity vasculitis, neurosensory hypoacusis, psoriasis.

Some ocular IMAR cases can be associated with retinal detachment. Various grades of visual impairment, including blindness, can occur. If uveitis occurs in combination with other immune-mediated adverse reactions, consider a Vogt-Koyanagi-Harada–like syndrome, which has been observed in patients receiving OPDIVO and YERVOY, as this may require treatment with systemic corticosteroids to reduce the risk of permanent vision loss.

Infusion-Related Reactions OPDIVO and YERVOY can cause severe infusion-related reactions. Discontinue OPDIVO and YERVOY in patients with severe (Grade 3) or life-threatening (Grade 4) infusion-related reactions. Interrupt or slow the rate of infusion in patients with mild (Grade 1) or moderate (Grade 2) infusion-related reactions.

Complications of Allogeneic Hematopoietic Stem Cell Transplantation Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with OPDIVO or YERVOY. Transplant-related complications include hyperacute graft-versus-host-disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between OPDIVO or YERVOY and allogeneic HSCT.

Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with OPDIVO and YERVOY prior to or after an allogeneic HSCT.

Embryo-Fetal Toxicity Based on its mechanism of action and findings from animal studies, OPDIVO and YERVOY can cause fetal harm when administered to a pregnant woman. The effects of YERVOY are likely to be greater during the second and third trimesters of pregnancy. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with OPDIVO and YERVOY and for at least 5 months after the last dose.

Increased Mortality in Patients with Multiple Myeloma when OPDIVO is Added to a Thalidomide Analogue and Dexamethasone In randomized clinical trials in patients with multiple myeloma, the addition of OPDIVO to a thalidomide analogue plus dexamethasone resulted in increased mortality. Treatment of patients with multiple myeloma with a PD-1 or PD-L1 blocking antibody in combination with a thalidomide analogue plus dexamethasone is not recommended outside of controlled clinical trials.

Lactation There are no data on the presence of OPDIVO or YERVOY in human milk, the effects on the breastfed child, or the effects on milk production. Because of the potential for serious adverse reactions in breastfed children, advise women not to breastfeed during treatment and for 5 months after the last dose.

Serious Adverse Reactions In Checkmate 227, serious adverse reactions occurred in 58% of patients (n=576). The most frequent (≥2%) serious adverse reactions were pneumonia, diarrhea/colitis, pneumonitis, hepatitis, pulmonary embolism, adrenal insufficiency, and hypophysitis. Fatal adverse reactions occurred in 1.7% of patients; these included events of pneumonitis (4 patients), myocarditis, acute kidney injury, shock, hyperglycemia, multi-system organ failure, and renal failure. In Checkmate 9LA, serious adverse reactions occurred in 57% of patients (n=358). The most frequent (>2%) serious adverse reactions were pneumonia, diarrhea, febrile neutropenia, anemia, acute kidney injury, musculoskeletal pain, dyspnea, pneumonitis, and respiratory failure. Fatal adverse reactions occurred in 7 (2%) patients, and included hepatic toxicity, acute renal failure, sepsis, pneumonitis, diarrhea with hypokalemia, and massive hemoptysis in the setting of thrombocytopenia.

Common Adverse Reactions In Checkmate 227, the most common (≥20%) adverse reactions were fatigue (44%), rash (34%), decreased appetite (31%), musculoskeletal pain (27%), diarrhea/colitis (26%), dyspnea (26%), cough (23%), hepatitis (21%), nausea (21%), and pruritus (21%). In Checkmate 9LA, the most common (>20%) adverse reactions were fatigue (49%), musculoskeletal pain (39%), nausea (32%), diarrhea (31%), rash (30%), decreased appetite (28%), constipation (21%), and pruritus (21%).

Clinical Trials and Patient Populations Checkmate 227–previously untreated metastatic non-small cell lung cancer, in combination with YERVOY; Checkmate 9LA–previously untreated recurrent or metastatic non-small cell lung cancer in combination with YERVOY and 2 cycles of platinum-doublet chemotherapy by histology.

Please see US Full Prescribing Information for OPDIVO and YERVOY.


References:

  1. OPDIVO [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2021.
  2. Hellmann MD, Paz-Ares L, Bernabe Caro R, et al. Nivolumab plus ipilimumab in advanced non-small-cell lung cancer. N Engl J Med. 2019;381(21):2020-2031.
  3. Paz-Ares LG, Ciuleanu TE, Lee JS, et al. Nivolumab + ipilimumab vs chemotherapy as first-line treatment for advanced non-small cell lung cancer: 4-year update from CheckMate 227. Oral presentation at ASCO 2021; June 4-8; Virtual. Abstract 9016.
  4. Hellmann MD, Paz-Ares L, Bernabe Caro R, et al. Nivolumab plus ipilimumab in advanced non-small-cell lung cancer. N Engl J Med. 2019;381(21):2020-2031 [supplementary appendix].
  5. Ramalingam SS, Ciuleanu TE, Pluzanski A, et al. Nivolumab + ipilimumab versus platinum-doublet chemotherapy as first-line treatment for advanced non-small cell lung cancer: Three-year update from Checkmate 227 Part 1. Oral presentation at ASCO 2020. Abstract 9500.
  6. Data on file. NIVO 566. Princeton, NJ: Bristol-Myers Squibb Company; 2020.
  7. Reck M, Ciuleanu TE, Cobo M, et al. First-line nivolumab + ipilimumab + 2 cycles of chemotherapy versus chemotherapy alone (4 cycles) in patients with advanced non-small cell lung cancer: 2-year update from CheckMate 9LA. Oral presentation at ASCO 2021; June 4-8; Virtual. Abstract 9000.
  8. Reck M, Ciuleanu TE, Dols MC, et al. Nivolumab + ipilimumab + 2 cycles of platinum-doublet chemotherapy vs 4 cycles chemo as first-line treatment for stage IV/recurrent non-small cell lung cancer: CheckMate 9LA. Oral presentation at ASCO 2020; May 29-31; Virtual. Abstract 9501.
  9. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V.4.2021. ©National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed April 1, 2021. To view the most recent and complete version of the guidelines, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use of the application and disclaims any responsibility for their application or use in any way.
  10. Data on file. NIVO 562. Princeton, NJ: Bristol-Myers Squibb Company; 2020.
  11. YERVOY [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2020.
  12. Data on file. NIVO 606. Princeton, NJ: Bristol-Myers Squibb Company; 2020.