Comparison of Long-Term Survival Between Nivolumab Plus Ipilimumab and Nivolumab Plus Ipilimumab With Chemotherapy in Advanced NSCLC: A Multicenter Retrospective Cohort Study
In brief
Two cycles of chemo double response rate without extending survival
In a matched analysis of 94 advanced NSCLC patients, adding two cycles of platinum chemotherapy to nivolumab-ipilimumab raised the objective response rate to 68% versus 34% with immunotherapy alone, but median overall survival was similar (19.5 vs 16.3 months) and 36-month survival rates overlapped. The intensified regimen also caused more grade 3-plus toxicities, suggesting a trade-off between early tumor shrinkage and tolerability.
- Journal
- JTO clinical and research reports (Q1)
- Published
- 10 July 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Kiyohide Komuta, Kinnosuke Matsumoto, Motohiro Tamiya, Takayuki Shiroyama, Yuhei Kinehara, Akihiro Tamiya, et al.
- PMID
- 42699734
- DOI
- 10.1016/j.jtocrr.2026.101048
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (paper of the day, 8 September 2026): NICT vs NI in advanced NSCLC: higher response but more
Abstract
INTRODUCTION: Pivotal clinical trials have reported the survival benefits of both nivolumab plus ipilimumab (NI) and nivolumab plus ipilimumab with 2 cycles of platinum-based chemotherapy (NICT) compared with chemotherapy. However, real-world evidence comparing NI and NICT with long-term follow-up remains limited. METHODS: We retrospectively analyzed 181 patients treated with NICT or NI across 13 institutions in Japan. The primary end points were median overall survival (OS) and the 36-month OS rate. Secondary end points included progression-free survival (PFS), objective response rate, disease control rate, and treatment-related adverse events (TRAEs). To reduce treatment-selection bias, 1:1 propensity score matching was performed using 11 covariates. RESULTS: In the post-propensity score matching cohort (47 pairs; n = 94; median follow-up, 42.6 and 44.1 months), the median PFS was 8.7 months with NICT versus 4.7 months with NI (hazard ratio [HR] 0.86; p = 0.51). The median OS was 19.5 months with NICT versus 16.3 months with NI (HR 0.79; p = 0.37), with similar 36-month OS rates (34.3% versus 30.9%). The objective response rate was significantly higher with NICT than with NI (68.1% versus 34.0%) (p = 0.002), as was the disease control rate (83.0% versus 53.2%) (p = 0.004). NICT was associated with a higher cumulative incidence of TRAEs of grade 3 or higher (HR 2.25 [95% confidence interval, 1.03-4.91]) (Gray's test p = 0.039). Treatment discontinuation and treatment-related deaths were comparable between the groups. CONCLUSIONS: With more than 40 months of follow-up, NICT was associated with higher response rates and a higher incidence of TRAEs of grade 3 or higher than NI, without a clear PFS or OS advantage. Adding 2-cycles of chemotherapy may enhance early disease control but at the cost of increased toxicity, and this balance should be considered when selecting treatment for patients for whom tolerability is a major concern.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.