Nivolumab vs Standard of Care for Third-Line Treatment of SCLC

Findings from a comparative effectiveness analysis of nivolumab and standard of care for the third-line treatment of small cell lung cancer (SCLC) show that nivolumab was more effective (J Comp Eff Res. 2020;9[18]:1275-1284. doi:10.2217/cer-2020-0134).

This study aimed to estimate the comparative effectiveness of nivolumab vs standard of care in terms of overall survival (OS) for the treatment of SCLC in the third-line setting.  

Individual patient data from the CheckMate 032 trial and Flatiron Health electronic health record database were used for the study. Three different methods were used for comparisons of OS (multivariable regression adjustment, inverse probability weighting and a doubly robust method) to adjust for differences between the populations.

A total of 156 patients who received third-line nivolumab (n = 78) or standard of care (n = 78) were included in the study. The median OS estimate for patients receiving third-line nivolumab monotherapy in CheckMate 032 was 5.7 months, with a 1-year OS estimate of 28%. The median OS estimate for patients receiving standard of care in the Flatiron cohort was 3.8 months, with a 1-year OS estimate of 4%.

The naïve, unadjusted comparison found nivolumab more effective compared with standard of care (HR: 0.63; 95% CI: 0.44-0.90). Similar to the naive comparison, multivariable regression adjustment (HR: 0.59; 95% CI: 0.39–0.88), inverse probability weighting (HR: 0.70; 95% CI: 0.54–0.89), and doubly robust method (HR: 0.68; 95% CI: 0.52–0.90) all showed nivolumab to be more effective than standard of care.

“For patients with advanced SCLC who have failed two prior lines of chemotherapy, patient-level analyses to compare single-arm trial data with that from a real-world cohort suggest that nivolumab monotherapy improves OS compared with SOC in the USA,” concluded Sam Keeping, MSc, Precision HEOR, Vancouver, and colleagues.—Janelle Bradley