Low‐Dose Nivolumab in Various Cancers: A Real‐World Exploratory Analysis in Resource‐Constrained Settings
Subhas Pandit, Simit Sapkota, Abish Adhikari, Jeebana Bhandari, Sunil Shrestha, Rajani Jha, Gerim Prasai, Anjani Kr. JhaABSTRACT
Background
Immune checkpoint inhibitors (ICIs), including nivolumab, have significantly improved cancer care. However, due to high costs, there is a significant financial barrier to their widespread access. Emerging evidence shows biological plausibility as well as efficacy of low‐dose nivolumab across different cancers.
Aims
This exploratory study aims to investigate the clinical outcomes of low‐dose nivolumab in cancer treatment to explore the potential to improve its access by reducing costs, especially in resource‐limited settings.
Methods and Results
Data on patients with various malignancies treated with fixed 20 or 40 mg of nivolumab every 3 weeks were retrospectively analyzed. Response to the treatment, including the best objective response rate, best disease control rate, and adverse events, was reported. The Kaplan–Meier method was used to determine progression‐free survival and overall survival. The patient cohort of 31 patients with various tumors received a median of 9 cycles (range, 2–20) of low‐dose nivolumab therapy for 5.7 months (range, 0.7–17.1). Median follow‐up was 8.6 months (95% CI, 7.1–12.9). Disease control was achieved in 21/31 (67.7%) patients, with the best objective response rate of 51.6%. The median progression‐free survival was 8.8 months (95% CI, 6.6‐not reached) and overall survival was 14.8 months (95% CI, 11.1‐not reached). At the end of the study period, 3/31 patients had a radiologic complete response, 9/31 had a partial response, 4/31 had stable disease, and 6/31 had progressive disease, and 3/31 were not evaluable; 6 patients died during this period. The responses achieved were sustainable for a median of 4 months (range, 0.8–8.2). Only 5 patients developed adverse events of grade 2 or 3.
Conclusions
Low‐dose nivolumab shows preliminary efficacy in resource‐constrained settings. Further research should explore optimal dosing and scheduling for low‐dose immunotherapy and evaluate its efficacy and safety through larger, homogeneous studies.