PT - JOURNAL ARTICLE AU - Schenker, Michael AU - Burotto, Mauricio AU - Richardet, Martin AU - Ciuleanu, Tudor-Eliade AU - Gonçalves, Anthony AU - Steeghs, Neeltje AU - Schoffski, Patrick AU - Ascierto, Paolo A AU - Maio, Michele AU - Lugowska, Iwona AU - Lupinacci, Lorena AU - Leary, Alexandra AU - Delord, Jean-Pierre AU - Grasselli, Julieta AU - Tan, David S P AU - Friedmann, Jennifer AU - Vuky, Jacqueline AU - Tschaika, Marina AU - Konduru, Somasekhar AU - Vemula, Sai Vikram AU - Slepetis, Ruta AU - Kollia, Georgia AU - Pacius, Misena AU - Duong, Quyen AU - Huang, Ning AU - Doshi, Parul AU - Baden, Jonathan AU - Di Nicola, Massimo TI - 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 AID - 10.1136/jitc-2024-008872 DP - 2024 Aug 01 TA - Journal for ImmunoTherapy of Cancer PG - e008872 VI - 12 IP - 8 4099 - http://jitc.bmj.com/content/12/8/e008872.short 4100 - http://jitc.bmj.com/content/12/8/e008872.full SO - J Immunother Cancer2024 Aug 01; 12 AB - Background Checkpoint inhibitor therapy has demonstrated overall survival benefit in multiple tumor types. Tumor mutational burden (TMB) is a predictive biomarker for response to immunotherapies. This study evaluated the efficacy of nivolumab+ipilimumab in multiple tumor types based on TMB status evaluated using either tumor tissue (tTMB) or circulating tumor DNA in the blood (bTMB).Patients and methods Patients with metastatic or unresectable solid tumors with high (≥10 mutations per megabase) tTMB (tTMB-H) and/or bTMB (bTMB-H) who were refractory to standard therapies were randomized 2:1 to receive nivolumab+ipilimumab or nivolumab monotherapy in an open-label, phase 2 study (CheckMate 848; NCT03668119). tTMB and bTMB were determined by the Foundation Medicine FoundationOne® CDx test and bTMB Clinical Trial Assay, respectively. The dual primary endpoints were objective response rate (ORR) in patients with tTMB-H and/or bTMB-H tumors treated with nivolumab+ipilimumab.Results In total, 201 patients refractory to standard therapies were randomized: 135 had tTMB-H and 125 had bTMB-H; 82 patients had dual tTMB-H/bTMB-H. In patients with tTMB-H, ORR was 38.6% (95% CI 28.4% to 49.6%) with nivolumab+ipilimumab and 29.8% (95% CI 17.3% to 44.9%) with nivolumab monotherapy. In patients with bTMB-H, ORR was 22.5% (95% CI 13.9% to 33.2%) with nivolumab+ipilimumab and 15.6% (95% CI 6.5% to 29.5%) with nivolumab monotherapy. Early and durable responses to treatment with nivolumab+ipilimumab were seen in patients with tTMB-H or bTMB-H. The safety profile of nivolumab+ipilimumab was manageable, with no new safety signals.Conclusions Patients with metastatic or unresectable solid tumors with TMB-H, as determined by tissue biopsy or by blood sample when tissue biopsy is unavailable, who have no other treatment options, may benefit from nivolumab+ipilimumab.Trial registration number NCT03668119.Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Bristol Myers Squibb will honor legitimate requests for clinical trial data from qualified researchers with a clearly defined scientific objective. Data sharing requests will be considered for phases II–IV interventional clinical trials that completed on or after January 1, 2008. In addition, primary results must have been published in peer-reviewed journals and the medicines or indications approved in the USA, EU, and other designated markets. Sharing is also subject to protection of patient privacy and respect for the patient’s informed consent. Data considered for sharing may include non-identifiable patient-level and study-level clinical trial data, full clinical study reports, and protocols. Requests to access clinical trial data may be submitted using the enquiry form at https://vivli.org/ourmember/bristol-myers-squibb/.