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Girard N, Ponce Aix S, Cedres S, Berghmans T, Burgers S, Toffart AC, Popat S, Janssens A, Gervais R, Hochstenbag M, Silva M, Burger IA, Prosch H, Stahel R, Xenophontos E, Pretzenbaher Y, Neven A, Peters S. Efficacy and safety of nivolumab for patients with pre-treated type B3 thymoma and thymic carcinoma: results from the EORTC-ETOP NIVOTHYM phase II trial. ESMO Open 2023; 8:101576. [PMID: 37285717 DOI: 10.1016/j.esmoop.2023.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Thymic malignancies are rare intrathoracic tumors, which may be aggressive and difficult to treat. They represent a therapeutic challenge in the advanced/metastatic setting, with limited treatment options after the failure of first-line platinum-based chemotherapy. They are frequently associated with autoimmune disorders that also impact oncological management. MATERIALS AND METHODS NIVOTHYM is an international, multicenter, phase II, two-cohort, single-arm trial evaluating the activity and safety of nivolumab [240 mg intravenously (i.v.) q2 weeks] alone or with ipilimumab (1 mg /kg i.v. q6 weeks) in patients with advanced/relapsed type B3 thymoma or thymic carcinoma, after exposure to platinum-based chemotherapy. The primary endpoint is progression-free survival rate at 6 months (PFSR-6) based on RECIST 1.1 as per independent radiological review. RESULTS From April 2018 to February 2020, 55 patients were enrolled in 15 centers from 5 countries. Ten patients (18%) had type B3 thymoma and 43 (78%) had thymic carcinoma. The majority were male (64%), and the median age was 58 years. Among the 49 eligible patients who started treatment, PFSR-6 by central review was 35% [95% confidence interval (CI) 22% to 50%]. The overall response rate and disease control rate were 12% (95% CI 5% to 25%) and 63% (95% CI 48% to 77%), respectively. Using the Kaplan-Meier method, median progression-free survival and overall survival by local assessment were 6.0 (95% CI 3.1-10.4) months and 21.3 (95% CI 11.6-not estimable) months, respectively. In the safety population of 54 patients, adverse events (AEs) of grade 1/2 were observed in 22 (41%) patients and grade 3/4 in 31 (57%) patients. Treatment-related AEs of grade 4 included one case of neutropenia, one case of immune-mediated transaminitis, and two cases of myocarditis. CONCLUSIONS Nivolumab monotherapy demonstrated an acceptable safety profile and objective activity, although it has been insufficient to meet its primary objective. The second cohort of NIVOTHYM is currently ongoing to assess the combination of nivolumab plus ipilimumab.
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Affiliation(s)
- N Girard
- Thorax Institute Curie Montsouris, Institut Curie, Paris, France and Paris Saclay University, UVSQ, Versailles, France.
| | - S Ponce Aix
- Hospital Universitario 12 De Octubre, Madrid, Spain
| | - S Cedres
- Hospital Universitari Vall d'Hebron-Vall d'Hebron Institut Oncologia, Barcelona, Spain
| | - T Berghmans
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Burgers
- The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis, Amsterdam, The Netherlands
| | - A-C Toffart
- CHU de Grenoble-La Tronche-Hôpital A. Michallon, Grenoble, France
| | - S Popat
- Royal Marsden Hospital-Chelsea, London, UK
| | - A Janssens
- Universitair Ziekenhuis Antwerpen, Antwerp, Belgium
| | - R Gervais
- Centre Francois Baclesse (CLCC), Caen, France
| | - M Hochstenbag
- Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - M Silva
- Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - H Prosch
- Medical University of Vienna, Vienna, Austria
| | - R Stahel
- ETOP IBCSG Partners Foundation, Berne, Switzerland
| | | | | | - A Neven
- Luxembourg Institute of Health, Competence Center for Methodology and Statistics, Strassen, Luxembourg
| | - S Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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