Nicholas Hornstein, Assistant Professor at Northwell Health, shared a post on LinkedIn:
“ATTRACTION-6: Nivolumab plus ipilimumab combined with chemotherapy against chemo in 1L HER2-negative G/GEJ cancer.
Dual-checkpoint has a home in multiple diseases: melanoma, PD-L1 negative NSCLC, MSI-H cancers, and HCC among them.
But in unselected HER2-negative gastric/GEJ cancer, adding ipilimumab to nivolumab + chemotherapy did not get it done.
ATTRACTION-6 randomized 626 patients in Japan, Korea, and Taiwan with previously untreated HER2-negative unresectable advanced or recurrent G/GEJ cancer to NIVO + IPI + chemo vs chemo alone.
Quick hits.
Primary endpoint negative:
- Median OS: 15.7 vs 15.8 months
- HR 0.90
- P=0.267
PFS moved a little:
- 8.9 vs 7.7 months
- HR 0.83
ORR was higher:
- 57.9% vs 38.5%
Toxicity increased:
- Grade ≥3 TRAEs: 64.8% vs 42.9%
The signal here is pretty clear: more immune therapy increased response and toxicity, but did not improve survival.
Dual-checkpoint is extremely effective in the right disease, and maybe the right biomarker-selected upper GI population, but ATTRACTION-6 is not that win.
Long live dual-checkpoint.
Just not here.”
Title: Nivolumab plus ipilimumab combined with chemotherapy as first-line treatment for HER2-negative unresectable advanced or recurrent gastric/gastroesophageal junction cancer: A randomized phase 3 trial (ATTRACTION-6).
Author: Do-Youn Oh
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