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Motzer RJ , Escudier B , McDermott DF , George S , Hammers HJ , Srinivas S , Tykodi SS , Sosman JA , Procopio G , Plimack ER , Castellano D , Choueiri TK , Gurney H , Donskov F , Bono P , Wagstaff J , Gauler TC , Ueda T , Tomita Y , Schutz FA , Kollmannsberger C , Larkin J , Ravaud A , Simon JS , Xu LA , Waxman IM , Sharma P , CheckMate Investigators
Nivolumab versus Everolimus in Advanced Renal-Cell Carcinoma
N Engl J Med. 2015 Nov 5;373(19) :1803-13
PMID: 26406148    PMCID: PMC5719487    URL: http://www.ncbi.nlm.nih.gov/pubmed/26406148
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BACKGROUND: Nivolumab, a programmed death 1 (PD-1) checkpoint inhibitor, was associated with encouraging overall survival in uncontrolled studies involving previously treated patients with advanced renal-cell carcinoma. This randomized, open-label, phase 3 study compared nivolumab with everolimus in patients with renal-cell carcinoma who had received previous treatment. METHODS: A total of 821 patients with advanced clear-cell renal-cell carcinoma for which they had received previous treatment with one or two regimens of antiangiogenic therapy were randomly assigned (in a 1:1 ratio) to receive 3 mg of nivolumab per kilogram of body weight intravenously every 2 weeks or a 10-mg everolimus tablet orally once daily. The primary end point was overall survival. The secondary end points included the objective response rate and safety. RESULTS: The median overall survival was 25.0 months (95% confidence interval [CI], 21.8 to not estimable) with nivolumab and 19.6 months (95% CI, 17.6 to 23.1) with everolimus. The hazard ratio for death with nivolumab versus everolimus was 0.73 (98.5% CI, 0.57 to 0.93; P=0.002), which met the prespecified criterion for superiority (P</=0.0148). The objective response rate was greater with nivolumab than with everolimus (25% vs. 5%; odds ratio, 5.98 [95% CI, 3.68 to 9.72]; P<0.001). The median progression-free survival was 4.6 months (95% CI, 3.7 to 5.4) with nivolumab and 4.4 months (95% CI, 3.7 to 5.5) with everolimus (hazard ratio, 0.88; 95% CI, 0.75 to 1.03; P=0.11). Grade 3 or 4 treatment-related adverse events occurred in 19% of the patients receiving nivolumab and in 37% of the patients receiving everolimus; the most common event with nivolumab was fatigue (in 2% of the patients), and the most common event with everolimus was anemia (in 8%). CONCLUSIONS: Among patients with previously treated advanced renal-cell carcinoma, overall survival was longer and fewer grade 3 or 4 adverse events occurred with nivolumab than with everolimus. (Funded by Bristol-Myers Squibb; CheckMate 025 ClinicalTrials.gov number, NCT01668784.).
Motzer, Robert J Escudier, Bernard McDermott, David F George, Saby Hammers, Hans J Srinivas, Sandhya Tykodi, Scott S Sosman, Jeffrey A Procopio, Giuseppe Plimack, Elizabeth R Castellano, Daniel Choueiri, Toni K Gurney, Howard Donskov, Frede Bono, Petri Wagstaff, John Gauler, Thomas C Ueda, Takeshi Tomita, Yoshihiko Schutz, Fabio A Kollmannsberger, Christian Larkin, James Ravaud, Alain Simon, Jason S Xu, Li-An Waxman, Ian M Sharma, Padmanee eng Clinical Trial, Phase III Comparative Study Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't 2015/09/26 06:00 N Engl J Med. 2015 Nov 5;373(19):1803-13. doi: 10.1056/NEJMoa1510665. Epub 2015 Sep 25.