Which therapy is safer to use in patients with advanced cancers?

In the management of advanced cancers, physicians and their patients may prefer treatment with nivolumab 3 mg/kg biweekly, nivolumab 240 mg weekly, or nivolumab 3 mg/kg plus ipilimumab 1 mg/kg triweekly due to their relatively low risk of treatment-related adverse events (TRAEs), treatment discontinuation due to TRAEs (TDAE), and serious adverse events (SAEs), suggests a study.

A team of investigators searched the databases of PubMed, Embase, and Central for randomized controlled trials (RCTs) of nivolumab and ipilimumab. They carried out a network meta-analysis using the Bayesian approach in R version 4.0.3. Outcomes measured were TRAEs, TRAEs of grades 3‒5, TDAEs, TDAEs of grades 3‒5, SAEs, and SAEs of grades 3‒5.

Forty-two RCTs met the eligibility criteria for meta-analysis. The treatment ranking for TRAEs showed that nivolumab 240 mg/week and 3 mg/kg/week were safer (0.84 and 0.81 in surface under the cumulative ranking curve [SUCRA], respectively), while nivolumab 3 mg/kg/week and 240 mg/week were safer for TRAEs of grades 3‒5 (0.83 and 0.75 in SUCRA, respectively).

For TDAEs, nivolumab 3 mg/kg/week and ipilimumab combined with other drugs were safer (0.87 and 0.64 in SUCRA, respectively); for TDAEs of grades 3‒5, nivolumab 3 mg/kg/week was safer (0.85 in SUCRA). Finally, nivolumab 3 mg/kg/week and 240 mg/week were safer for SAEs (0.79 and 0.76 in SUCRA, respectively), and nivolumab 3 mg/kg/week was safer for SAEs of grades 3‒5 (0.78 in SUCRA).

“Immune checkpoint inhibitors have changed the landscape of management of advanced cancers,” the investigators said. “It is imperative to evaluate the safety of nivolumab- and ipilimumab-based therapies.”