Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial
Authors
Fennell, D. A.Ewings, S.
Ottensmeier, C.
Califano, Raffaele
Hanna, G. G.
Hill, K.
Danson, S.
Steele, N.
Nye, M.
Johnson, L.
Lord, J.
Middleton, C.
Szlosarek, P.
Chan, S.
Gaba, A.
Darlison, L.
Wells-Jordan, P.
Richards, C.
Poile, C.
Lester, J. F.
Griffiths, G.
Affiliation
Mesothelioma Research Programme, Leicester Cancer Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UKIssue Date
2021
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Background: No phase 3 trial has yet shown improved survival for patients with pleural or peritoneal malignant mesothelioma who have progressed following platinum-based chemotherapy. The aim of this study was to assess the efficacy and safety of nivolumab, an anti-PD-1 antibody, in these patients. Methods: This was a multicentre, placebo-controlled, double-blind, parallel group, randomised, phase 3 trial done in 24 hospitals in the UK. Adult patients (aged ?18 years) with an Eastern Cooperative Oncology Group performance status of 0 or 1, with histologically confirmed pleural or peritoneal mesothelioma, who had received previous first-line platinum-based chemotherapy and had radiological evidence of disease progression, were randomly assigned (2:1) to receive nivolumab at a flat dose of 240 mg every 2 weeks over 30 min intravenously or placebo until disease progression or a maximum of 12 months. The randomisation sequence was generated within an interactive web response system (Alea); patients were stratified according to epithelioid versus non-epithelioid histology and were assigned in random block sizes of 3 and 6. Participants and treating clinicians were masked to group allocation. The co-primary endpoints were investigator-assessed progression-free survival and overall survival, analysed according to the treatment policy estimand (an equivalent of the intention-to-treat principle). All patients who were randomly assigned were included in the safety population, reported according to group allocation. This trial is registered with Clinicaltrials.gov, NCT03063450. Findings: Between May 10, 2017, and March 30, 2020, 332 patients were recruited, of whom 221 (67%) were randomly assigned to the nivolumab group and 111 (33%) were assigned to the placebo group). Median follow-up was 11�6 months (IQR 7�2-16�8). Median progression-free survival was 3�0 months (95% CI 2�8-4�1) in the nivolumab group versus 1�8 months (1�4-2�6) in the placebo group (adjusted hazard ratio [HR] 0�67 [95% CI 0�53-0�85; p=0�0012). Median overall survival was 10�2 months (95% CI 8�5-12�1) in the nivolumab group versus 6�9 months (5�0-8�0) in the placebo group (adjusted HR 0�69 [95% CI 0�52-0�91]; p=0�0090). The most frequently reported grade 3 or worse treatment-related adverse events were diarrhoea (six [3%] of 221 in the nivolumab group vs two [2%] of 111 in the placebo group) and infusion-related reaction (six [3%] vs ). Serious adverse events occurred in 90 (41%) patients in the nivolumab group and 49 (44%) patients in the placebo group. There were no treatment-related deaths in either group.Citation
Fennell DA, Ewings S, Ottensmeier C, Califano R, Hanna GG, Hill K, et al. Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial. The Lancet Oncology. Elsevier BV; 2021.Journal
Lancet OncologyDOI
10.1016/s1470-2045(21)00471-xPubMed ID
34656227Additional Links
https://dx.doi.org/10.1016/s1470-2045(21)00471-xType
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1016/s1470-2045(21)00471-x
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