Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Few DLBCL patients benefit from nivolumab
J Clin Oncol; 2019 Feb; Ansell, et al
Key clinical point: Nivolumab may provide a benefit for a small group of patients with diffuse large B-cell lymphoma who have failed a transplant or are ineligible for one. Major finding: Nivolumab produced a response in 10 of 121 patients, including three complete responses. Study details: A phase 2 study of 121 patients with relapsed/refractory diffuse large B-cell lymphoma. Disclosures: This research was supported by Bristol-Myers Squibb and other organizations. The study authors reported relationships with Bristol-Myers Squibb and other companies. Source: Ansell SM et al. J Clin Oncol. 2019 Jan 8. doi: 10.1200/JCO.18.00766.
Dr. David Henry, Editor in Chief of MDedge Hematology/Oncology, comments:
In this study, Dr. Ansell and colleagues report the failure of nivolumab to work in the majority of 121 relapsed/refractory DLBCL patients. While this is a negative study, 10 patients did respond, with three achieving a complete response lasting 11 months or more.
Although it is disappointing that this study of the PD1 inhibitor nivolumab was largely a negative trial, the authors were intrigued by those who did respond and tried desperately to find out what was different about these 10 responders so that this knowledge might be applied to other relapsed/refractory DLBCL patients.
Some responders did have the 9p24.1 alteration, but others did not. None of those responders tested positive for the PD-L1 ligand and only one responder had detectable PD-L2 expression.
In this era of immuno-oncology, where some five antibodies are FDA approved in various cancers, it is equally important to have reports like this one detailing where an immuno-oncology antibody does not work, and also to try and understand better what biomarkers predict a positive response for those few patients where it might work.
We await with interest more information on this responder group and what biomarkers that might be useful for patients in this relapsed/refractory DLBCL category.