Guru P. Sonpavde, MD, Director of the Bladder Cancer Program at Dana-Farber Cancer Institute and a faculty member of Harvard Medical School, Boston, said these follow-up data from CheckMate 274 provide reassurance that the disease-free survival benefit is maintained with adjuvant nivolumab.

“We don’t have survival data yet, but we know that disease-free survival correlates with overall survival quite nicely in the perioperative platinum-based chemotherapy setting. Furthermore, with immune checkpoint inhibitors, the duration of benefit tends to be even longer than with chemotherapy,” Dr. Sonpavde told The ASCO Post. “I do think this benefit will translate to survival, but even if it does not, the improvement in median disease-free survival is robust. Even in the absence of a survival benefit, however, you can make the case that this disease-free survival benefit by itself is robust enough for adjuvant nivolumab to be considered a standard of care,” he added.

Guru P. Sonpavde, MD

Dr. Sonpavde also highlighted the study’s use of a combined positive score (CPS, ie, the number of PD-L1–positive tumor cells, lymphocytes, and macrophages, divided by the total number of viable tumor cells multiplied by 100) vs a tumor proportion score (TPS, ie, the percentage of viable tumor cells showing partial or complete membrane staining at any intensity) to assess PD-L1 expression. As Dr. Sonpavde explained, a CPS score of at least 1 is a lower cutoff, with nearly 90% of enrolled patients meeting that criterion. Conversely, only approximately one-third of patients had a TPS score of at least 1. Findings showed that patients benefited even with the apparently “lower bar” of a CPS, but Dr. Sonpavde noted this analysis was not needed to convince him of the benefit for all-comers. Data from the AMBASSADOR trial evaluating adjuvant pembrolizumab are eagerly awaited, in the context of the previously reported data from ­IMvigor010 evaluating adjuvant atezolizumab that did not demonstrate benefit.

“I am using nivolumab as adjuvant therapy in everybody who satisfies the eligibility criteria for high-risk disease, regardless of PD-L1 expression and have considered using circulating tumor DNA for minimal residual disease assessment to guide therapy,” he concluded. 

DISCLOSURE: Dr. Sonpavde reported no conflicts of interest.