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NCT03668119: CheckMate 848

A Study of Nivolumab Combined With Ipilimumab and Nivolumab Alone in Patients With Advanced or Metastatic Solid Tumors of High Tumor Mutational Burden (TMB-H)

Completed Phase 2 Results posted Last updated 28 August 2024
What this trial tests

Phase 2 trial testing Nivolumab in Pan Tumor in 212 participants. Completed in 2 August 2023.

Timeline
31 October 2018
Primary endpoint
3 May 2022
2 August 2023

Quick facts

Lead sponsorBristol-Myers Squibb
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment212
Start date31 October 2018
Primary completion3 May 2022
Estimated completion2 August 2023
Sites60 locations across Denmark, France, Italy, Netherlands, Belgium, Chile, United Kingdom, Germany

Drugs / interventions tested

Conditions studied

Sponsor

Bristol-Myers Squibb — full company profile →

Who can join

12 and older, any sex, with Pan Tumor. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Objective Response Rate (ORR) Per Blinded Independent Central Review (BICR) - Arm A Primary · From date of randomization up to 42 months

ORR was defined as the percentage of participants with a best overall response of confirmed complete response (CR) or partial response (PR) based on Blinded Independent Central Review (BICR) assessment. RECIST Criteria: CR= Disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \< 10 mm. PR= ≥ 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. RANO Criteria: CR= Disappearance of all enhancing measurable and nonmeasurable disease; stable or improved nonenhancing T2/FLAIR lesions; off cortic

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab22.513.9 – 33.2
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab38.628.4 – 49.6
Objective Response Rate (ORR) Per Blinded Independent Central Review (BICR) - Arm B Secondary · From date of randomization up to 57 months

ORR was defined as the percentage of participants with a best overall response of confirmed complete response (CR) or partial response (PR) based on Blinded Independent Central Review (BICR) assessment. RECIST Criteria: CR= Disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \< 10 mm. PR= ≥ 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. RANO Criteria: CR= Disappearance of all enhancing measurable and nonmeasurable disease; stable or improved nonenhancing T2/FLAIR lesions; off cortic

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm B: Nivolumab15.66.5 – 29.5
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm B: Nivolumab29.817.3 – 44.9
Objective Response Rate (ORR) Per Investigator Secondary · From date of randomization up to 57 months

ORR was defined as the percentage of participants with a best overall response of confirmed complete response (CR) or partial response (PR) based on investigator assessment. Calculated using Clopper-Pearson method. RECIST Criteria: CR= Disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \< 10 mm. PR= ≥ 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. RANO Criteria: CR= Disappearance of all enhancing measurable and nonmeasurable disease; stable or improved nonenhancing T2/FLAIR lesions

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab25.016.0 – 35.9
Arm B: Nivolumab13.35.1 – 26.8
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab44.333.7 – 55.3
Arm B: Nivolumab23.412.3 – 38.0
Duration of Response (DoR) Per Investigator Secondary · From date of randomization to date of first documented tumor progression, or date of death, whichever occurs first (Up to 57 months)

DoR was defined as the time from first confirmed complete or partial response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first. Calculated using KM method. RECIST Criteria: CR= Disappearance of all target lesions. PR= ≥ 30% decrease in the sum of diameters of target lesions. PD= ≥ 20% increase in the sum of diameters of target lesions. RANO Criteria: CR= Disappearance of all enhancing measurable and nonmeasurable disease; stable/improved T2/FLAIR; off corticosteroids; stable/improved clinically PR= ≥ 50% decrease in the sum of diamete

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab27.9611.20 – NA
Arm B: NivolumabNA11.24 – NA
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+IpilimumabNA27.96 – NA
Arm B: NivolumabNA8.05 – NA
Duration of Response (DoR) Per Blinded Independent Central Review (BICR) Secondary · From date of randomization to date of first documented tumor progression, or date of death, whichever occurs first (Up to 57 months)

DoR was defined as the time from first confirmed complete or partial response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first. Calculated using KM method. RECIST Criteria: CR= Disappearance of all target lesions. PR= ≥ 30% decrease in the sum of diameters of target lesions. PD= ≥ 20% increase in the sum of diameters of target lesions. RANO Criteria: CR= Disappearance of all enhancing measurable and nonmeasurable disease; stable/improved T2/FLAIR; off corticosteroids; stable/improved clinically PR= ≥ 50% decrease in the sum of diamete

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+IpilimumabNA10.15 – NA
Arm B: NivolumabNA5.52 – NA
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+IpilimumabNA33.51 – NA
Arm B: NivolumabNA8.31 – NA
Time to Objective Response (TTR) Per Investigator Secondary · From date of randomization to date of first confirmed response (CR or PR) (Up to 57 months)

TTR is defined as the time from randomization date to the date of the first confirmed response (complete response (CR) or partial response (PR)), based on investigator assessment. RECIST Criteria: CR= Disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \< 10 mm. PR= ≥ 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. RANO Criteria: CR= Disappearance of all enhancing measurable and nonmeasurable disease; stable or improved nonenhancing T2/FLAIR lesions; off corticosteroids; and stable o

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab3.48± 1.17
Arm B: Nivolumab4.08± 3.40
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab3.56± 1.74
Arm B: Nivolumab3.75± 2.50
Time to Objective Response (TTR) Per Blinded Independent Central Review (BICR) Secondary · From date of randomization to date of first confirmed response (CR or PR) (Up to 57 months)

TTR is defined as the time from randomization date to the date of the first confirmed response (complete response (CR) or partial response (PR)), based on Blinded Independent Central Review (BICR) assessment. RECIST Criteria: CR= Disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \< 10 mm. PR= ≥ 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. RANO Criteria: CR= Disappearance of all enhancing measurable and nonmeasurable disease; stable or improved nonenhancing T2/FLAIR lesions; off

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab3.59± 1.65
Arm B: Nivolumab4.33± 2.93
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab4.37± 5.10
Arm B: Nivolumab3.98± 2.47
Clinical Benefit Rate (CBR) Per Investigator Secondary · From date of randomization up to 57 months

CBR is defined as the percentage of participants with a best overall response of confirmed complete response (CR) or partial response (PR) or stable disease (SD) based on investigator assessment. RECIST Criteria: CR= Disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \< 10 mm PR= ≥ 30% decrease in the sum of diameters of target lesions SD= Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD RANO Criteria: CR= Disappearance of all enhancing disease; stable or improved nonenhancing T2/FLAIR lesions; off

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab42.531.5 – 54.1
Arm B: Nivolumab40.025.7 – 55.7
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab63.652.7 – 73.6
Arm B: Nivolumab46.832.1 – 61.9
Clinical Benefit Rate (CBR) Per Blinded Independent Central Review (BICR) Secondary · From date of randomization up to 57 months

CBR is defined as the percentage of participants with a best overall response of confirmed complete response (CR) or partial response (PR) or stable disease (SD) per Blinded Independent Central Review (BICR) assessment. RECIST Criteria: CR= Disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to \< 10 mm PR= ≥ 30% decrease in the sum of diameters of target lesions SD= does not qualify for PR or progressive disease RANO Criteria: CR= Disappearance of all enhancing disease; stable or improved nonenhancing T2/FLAIR lesions; off corticosteroids; a

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab32.522.4 – 43.9
Arm B: Nivolumab28.916.4 – 44.3
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab53.442.5 – 64.1
Arm B: Nivolumab38.324.5 – 53.6
Progression Free Survival (PFS) Per Investigator Secondary · From date of randomization to date of first documented tumor progression, or date of death, whichever occurs first (Up to 57 months)

PFS is defined as the time from randomization date to the date of the first documented tumor progression, determined by investigator assessment, or death due to any cause, whichever occurs first. Calculated using KM method. RECIST Criteria: Progressive Disease (PD)= ≥ 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition, the sum must also demonstrate an absolute increase of ≥ 5 mm. RANO Criteria: PD= ≥ 25% increase in sum of the products of perpendicular diameters of enhancing lesions compared with the smallest tumor measurement

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab2.992.66 – 4.34
Arm B: Nivolumab3.042.79 – 5.36
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab8.154.83 – 12.94
Arm B: Nivolumab3.062.79 – 10.91
Progression Free Survival (PFS) Per Blinded Independent Central Review (BICR) Secondary · From date of randomization to date of first documented tumor progression, or date of death, whichever occurs first (Up to 57 months)

PFS is defined as the time from randomization date to the date of the first documented tumor progression, determined by Blinded Independent Central Review (BICR) assessment, or death due to any cause, whichever occurs first. Calculated using KM method. RECIST Criteria: Progressive Disease (PD)= ≥ 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition, the sum must also demonstrate an absolute increase of ≥ 5 mm. RANO Criteria: PD= ≥ 25% increase in sum of the products of perpendicular diameters of enhancing lesions compared with t

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab2.832.33 – 2.99
Arm B: Nivolumab2.832.60 – 3.25
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab5.683.19 – 11.60
Arm B: Nivolumab2.832.69 – 5.72
Overall Survival (OS) Secondary · From date of randomization to date of death (Up to 57 months)

OS is defined as the time between the date of randomization and the date of death due to any cause. Participants who did not have a date of death were censored on the last date for which a participant was known to be alive. Calculated using KM method.

Blood TMB-H (bTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab8.075.82 – 10.45
Arm B: Nivolumab11.245.26 – 18.99
Tissue TMB-H (tTMB-H)
GroupValue95% CI
Arm A: Nivolumab+Ipilimumab16.4810.18 – 30.52
Arm B: Nivolumab14.597.69 – 18.23

Adverse events — posted to ClinicalTrials.gov

Time frame: SAEs and AEs are assessed from first dose to 100 days post last dose (Up to 27 months). Participants were assessed for all-cause mortality from their first dose to study completion (Up to 57 months).. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Arm A: Nivolumab+Ipilimumab
Serious: 90/135 (67%)
Deaths: 97/136
Arm B: Nivolumab
Serious: 39/76 (51%)
Deaths: 42/76
Arm B: Nivolumab+Ipilimumab (Rollover)
Serious: 11/22 (50%)
Deaths: 20/22

Serious adverse events (102 terms)

ReactionSystemArm A: Nivolumab+IpilimumabArm B: NivolumabArm B: Nivolumab+Ipilimuma…
Malignant neoplasm progressionNeoplasms benign, malignant and unspecified (incl cysts and polyps)
PyrexiaGeneral disorders
ColitisGastrointestinal disorders
DiarrhoeaGastrointestinal disorders
Intestinal obstructionGastrointestinal disorders
VomitingGastrointestinal disorders
DeathGeneral disorders
FatigueGeneral disorders
PneumoniaInfections and infestations
Urinary tract infectionInfections and infestations
AnaemiaBlood and lymphatic system disorders
Adrenal insufficiencyEndocrine disorders
HypophysitisEndocrine disorders
Abdominal painGastrointestinal disorders
GastritisGastrointestinal disorders
General physical health deteriorationGeneral disorders
UrosepsisInfections and infestations
Blood creatinine increasedInvestigations
HypercalcaemiaMetabolism and nutrition disorders
Pain in extremityMusculoskeletal and connective tissue disorders
EncephalopathyNervous system disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Pleural effusionRespiratory, thoracic and mediastinal disorders
Superior vena cava syndromeVascular disorders
LeukopeniaBlood and lymphatic system disorders
Other adverse events (49 terms — click to expand)

ReactionSystemArm A: Nivolumab+IpilimumabArm B: NivolumabArm B: Nivolumab+Ipilimuma…
DiarrhoeaGastrointestinal disorders
FatigueGeneral disorders
PruritusSkin and subcutaneous tissue disorders
AnaemiaBlood and lymphatic system disorders
Decreased appetiteMetabolism and nutrition disorders
RashSkin and subcutaneous tissue disorders
Abdominal painGastrointestinal disorders
ConstipationGastrointestinal disorders
Oedema peripheralGeneral disorders
ArthralgiaMusculoskeletal and connective tissue disorders
PyrexiaGeneral disorders
Aspartate aminotransferase increasedInvestigations
DyspnoeaRespiratory, thoracic and mediastinal disorders
NauseaGastrointestinal disorders
VomitingGastrointestinal disorders
Alanine aminotransferase increasedInvestigations
HypothyroidismEndocrine disorders
Back painMusculoskeletal and connective tissue disorders
AstheniaGeneral disorders
CoughRespiratory, thoracic and mediastinal disorders
HyperthyroidismEndocrine disorders
Blood alkaline phosphatase increasedInvestigations
InsomniaPsychiatric disorders
Urinary tract infectionInfections and infestations
HypokalaemiaMetabolism and nutrition disorders
Blood creatinine increasedInvestigations
HyponatraemiaMetabolism and nutrition disorders
MyalgiaMusculoskeletal and connective tissue disorders
HeadacheNervous system disorders
COVID-19Infections and infestations
Blood bilirubin increasedInvestigations
HyperglycaemiaMetabolism and nutrition disorders
HypocalcaemiaMetabolism and nutrition disorders
Abdominal pain upperGastrointestinal disorders
Amylase increasedInvestigations
Blood glucose increasedInvestigations
HypoalbuminaemiaMetabolism and nutrition disorders
Pain in extremityMusculoskeletal and connective tissue disorders
HypotensionVascular disorders
ThrombocytopeniaBlood and lymphatic system disorders

Most-reported serious reactions: Malignant neoplasm progression, Pyrexia, Colitis, Diarrhoea, Intestinal obstruction, Vomiting, Death, Fatigue.

Data from ClinicalTrials.gov NCT03668119 adverse events section.

Sponsor's own description

The purpose of this study is to demonstrate the clinical activity of nivolumab in combination with ipilimumab in multiple types of tumors based on their Tumor Mutational Burden status.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Liquid biopsy approaches to capture tumor evolution and clinical outcomes during cancer immunotherapy.
    Sivapalan L, Murray JC, Canzoniero JV, Landon B, et al · · 2023 · cited 89× · PMID 36657818 · DOI 10.1136/jitc-2022-005924
  2. Tumor Mutational Burden, Toxicity, and Response of Immune Checkpoint Inhibitors Targeting PD(L)1, CTLA-4, and Combination: A Meta-regression Analysis.
    Osipov A, Lim SJ, Popovic A, Azad NS, et al · · 2020 · cited 88× · PMID 32586938 · DOI 10.1158/1078-0432.ccr-20-0458
  3. Tumor mutational burden in lung cancer: a systematic literature review.
    Willis C, Fiander M, Tran D, Korytowsky B, et al · · 2019 · cited 76× · PMID 31762941 · DOI 10.18632/oncotarget.27287
  4. Burden of tumor mutations, neoepitopes, and other variants are weak predictors of cancer immunotherapy response and overall survival.
    Wood MA, Weeder BR, David JK, Nellore A, et al · · 2020 · cited 74× · PMID 32228719 · DOI 10.1186/s13073-020-00729-2
  5. Machine learning-based prediction of microsatellite instability and high tumor mutation burden from contrast-enhanced computed tomography in endometrial cancers.
    Veeraraghavan H, Friedman CF, DeLair DF, Ninčević J, et al · · 2020 · cited 56× · PMID 33082371 · DOI 10.1038/s41598-020-72475-9
  6. Predictive Biomarkers of Immune Checkpoint Inhibition in Gastroesophageal Cancers.
    Sundar R, Smyth EC, Peng S, Yeong JPS, et al · · 2020 · cited 41× · PMID 32500029 · DOI 10.3389/fonc.2020.00763
  7. Immune profiling of pediatric solid tumors.
    Terry RL, Meyran D, Ziegler DS, Haber M, et al · · 2020 · cited 38× · PMID 32538896 · DOI 10.1172/jci137181
  8. Randomized, open-label, phase 2 study of nivolumab plus ipilimumab or nivolumab monotherapy in patients with advanced or metastatic solid tumors of high tumor mutational burden.
    Schenker M, Burotto M, Richardet M, Ciuleanu TE, et al · · 2024 · cited 30× · PMID 39107131 · DOI 10.1136/jitc-2024-008872

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