Adjuvant nivolumab versus placebo following radical surgery for high-risk muscle-invasive urothelial carcinoma: a subgroup analysis of Japanese patients enrolled in the phase 3 CheckMate 274 trial.

The phase 3 CheckMate 274 trial demonstrated superiority of adjuvant nivolumab over placebo after radical surgery in patients with high-risk muscle-invasive urothelial carcinoma. However, the efficacy and safety of adjuvant nivolumab in Japanese patients with muscle-invasive urothelial carcinoma have not been clarified.

Patients with muscle-invasive urothelial carcinoma were randomized to adjuvant nivolumab 240 mg or placebo (every 2 weeks via intravenous infusion) up to 120 days after radical surgery in CheckMate 274.

Of 49 patients in the Japanese subgroup, 27 and 22 patients were randomized to nivolumab and placebo, respectively. Eleven and 8 patients, respectively, had tumor PD-L1 expression level of 1% or more. The median disease-free survival times in the nivolumab and placebo groups were 29.67 months (95% confidence interval 7.79-not reached) and 9.72 months (95% confidence interval 4.73-not reached), respectively (hazard ratio 0.77, 95% confidence interval 0.35-1.69). The corresponding values in patients with tumor PD-L1 expression level of 1% or more were 29.67 months (95% confidence interval 2.63-not reached) and 25.95 months (95% confidence interval 5.59-not reached) (hazard ratio 1.10, 95% confidence interval 0.31-3.92), respectively. Treatment-related adverse events of Grade 3-4 occurred in 25.9 and 13.6% of patients in the nivolumab and placebo groups, respectively. The most common treatment-related adverse events in the nivolumab group were lipase increased, amylase increased and diarrhea. The changes in quality of life scores from baseline over time were similar in both groups.

The efficacy and safety results in the Japanese subgroup were consistent with the overall population of CheckMate 274.

Japanese journal of clinical oncology. 2022 Oct 26 [Epub ahead of print]

Yoshihiko Tomita, Ko Kobayashi, Go Kimura, Mototsugu Oya, Hirotsugu Uemura, Hiroyuki Nishiyama, Matthew D Galsky, Federico Nasroulah, Sandra Collette, Edward Broughton, Keziban Ünsal-Kaçmaz, Yukinori Kamisuki, Dean F Bajorin

Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan., Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan., Department of Urology, Nippon Medical School Hospital, Tokyo, Japan., Department of Urology, Keio University School of Medicine, Tokyo, Japan., Department of Urology, Kindai University Hospital, Faculty of Medicine, Osaka, Japan., Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan., Icahn School of Medicine at Mount Sinai, New York, NY, USA., Bristol-Myers Squibb, Princeton, NJ, USA., Ono Pharmaceutical Co., Ltd., Osaka, Japan., Memorial Sloan Kettering Cancer Center, New York, NY, USA.

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