ESMO 2024: practice-changing NIAGARA and KEYNOTE-522 data
Several studies have highlighted the success of immunotherapy in extending survival rates for numerous difficult-to-treat cancers.
Results from the CheckMate 067, KEYNOTE-006, KEYNOTE-522 and NIAGARA trials, which were recently presented at ESMO 2024 (September 13–17, Barcelona, Spain), have revealed promising outcomes for cancer patients undergoing immunotherapy.
CheckMate 067, a Phase III trial assessing the combination of immunotherapy and anti-PD-1-based therapy for advanced melanoma patients, demonstrated substantial benefits. A decade-long follow-up of CheckMate 067 revealed that the median survival rate for those undergoing immunotherapy with nivolumab plus ipilimumab was approximately 6 years. The 10-year melanoma-specific survival rate was 96%, suggesting the potential for this combination to serve as a significant advancement in the treatment of melanoma.
Marco Donia (Copenhagen University Hospital Herlev, Denmark), who is not a study author stated that: “The results from this trial do confirm the potential for cure with immunotherapy in patients with advanced melanoma. For patients who show no disease progression beyond 3 years, these longer-term results demonstrate that most of them never progress. The melanoma-specific survival is very high in this group of patients.”
Meanwhile, 10-year follow-up data from the KEYNOTE-006 study demonstrated that pembrolizumab continues to yield superior long-term efficacy to ipilimumab. Additionally, antitumor activity was observed in some patients who received second-course pembrolizumab. These findings support the establishment of pembrolizumab as the standard of care for advanced melanoma patients.
Early-stage triple-negative breast cancer, which is notoriously difficult to treat due to the absence of estrogen or progesterone receptors or have too low HER2 levels necessary for traditional treatment options, has also shown improved survival with immunotherapy. Patients who received a combination of immunotherapy and chemotherapy before surgery and continued the treatment post-surgery, experienced a 5.4% increase in 5-year survival compared to the placebo group.
“This study shows improvements with immunotherapy in patients with the most aggressive subtype of breast cancer, where previously we could only offer chemotherapy. We had thought that breast cancer may not be sensitive to immunotherapy alone but giving it in combination with chemotherapy before surgery and then further afterwards improves overall survival in many patients,” explained independent spokesperson Curioni-Fontecedro (University and Hospital of Fribourg, Switzerland).
Similar outcomes were noted in patients with muscle-invasive bladder cancer during the Phase-III NIAGARA study. Patients were randomly assigned to either a combined treatment plan of immunotherapy with durvalumab and chemotherapy before radical cystectomy, followed by continued immunotherapy, or a chemotherapy-only group followed by surgery. Those receiving the immunotherapy combination treatment plan experienced longer event-free survival and improved overall survival.
Looking ahead within immunotherapy research, Curioni-Fontecedro emphasized the need to understand: “why cancers recur in some patients despite initial response to immunotherapy. We still don’t understand how resistance to immunotherapy can occur in some patients. We need to understand what happens in these patients, what are the mechanisms of resistance and how we can overcome them”.