Updated
Updated · Nature.com · Aug 12
CheckMate 77T Links Nivolumab to 66% ctDNA Clearance in Resectable NSCLC
Updated
Updated · Nature.com · Aug 12

CheckMate 77T Links Nivolumab to 66% ctDNA Clearance in Resectable NSCLC

3 articles · Updated · Nature.com · Aug 12

Summary

  • Exploratory analyses in 190 biomarker-evaluable patients found perioperative nivolumab drove pre-surgical ctDNA clearance in 66% of evaluable cases versus 38% with placebo, and 50% of those cleared patients achieved pathologic complete response versus 12%.
  • All 13 patients who turned MRD-positive during adjuvant treatment later recurred, while fewer nivolumab patients converted from MRD-negative to MRD-positive after surgery—8% versus 20% with placebo.
  • Event-free survival remained better with nivolumab in the overall trial at 41 months' median follow-up, with a hazard ratio of 0.61 and 30-month EFS rates of 61% versus 43%.
  • Patients with KEAP1, STK11, CDKN2A or SMARCA4 alterations also appeared to benefit, with an EFS hazard ratio of 0.48, while a machine-learning model ranked ctDNA clearance, non-N2 disease, pCR, squamous histology and nivolumab among top predictors.

Insights

If high-risk tumor mutations usually signal a deadly recurrence, how is this new perioperative treatment suddenly defying the odds?
Are we over-treating lung cancer patients with costly immunotherapies when machine learning could pinpoint who actually needs them?