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Combination therapy shows promising progression-free survival in advanced non-small cell lung cancer patients with high PD-L1 expressionEarly trial shows two-drug combo may help advanced lung cancer patients

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Key Takeaway
Consider combination immunotherapy for high PD-L1 advanced NSCLC pending phase 3 confirmation.

This multicenter randomized phase 2 trial investigated the efficacy and safety of domvanalimab combined with zimberelimab versus zimberelimab alone or platinum-doublet chemotherapy. The study focused on patients with stage IIIB-IV non-small cell lung cancer who had high PD-L1 expression levels. The primary objective was to assess progression-free survival, with overall survival, objective response rate, and safety also evaluated as secondary outcomes.

The trial reported that the combination therapy resulted in a longer progression-free survival compared to the single-agent immunotherapy arm. Objective response rates were also higher with the combination approach. Safety analysis indicated that the incidence of severe treatment-related adverse events was lower with the combination than with chemotherapy, and no new safety concerns emerged during the study period.

The authors noted that overall survival data were not yet mature at the time of analysis. As a phase 2 study with a relatively small cohort, these results should be viewed as preliminary. The findings suggest potential benefit but require confirmation in larger, phase 3 trials before changing standard practice for this patient population.

This Phase 2 randomized trial looked at a treatment for patients with advanced non-small cell lung cancer. The study included 98 people who had high levels of PD-L1 and were in stage IIIB or IV disease. Participants were randomly assigned to receive either a combination of domvanalimab and zimberelimab with chemotherapy, zimberelimab with chemotherapy, or chemotherapy alone.

The main result measured how long patients lived without their cancer getting worse. The combination of domvanalimab and zimberelimab showed a longer time without progression compared to zimberelimab alone. The combination also showed a longer time without progression compared to chemotherapy alone. However, the confidence intervals for these comparisons included the possibility of no difference.

Overall survival and response rates were also measured. The combination therapy did not reach a final survival endpoint during the study follow-up. Response rates were slightly higher for the combination therapy than for the other groups. Safety data showed that serious side effects were reported less often with the new drugs than with chemotherapy alone. No new safety concerns were identified.

What this means for you:
This early trial suggests a two-drug combo might help some patients, but larger studies are needed to confirm benefits.

Study Details

Study typeRct
EvidenceLevel 2
PublishedMay 2026
View Original Abstract ↓
INTRODUCTION: TIGIT and PD-1 trigger distinct but interconnected immunosuppressive pathways. We investigated first-line domvanalimab (Fc-silent anti-TIGIT) plus zimberelimab (anti-PD-1) in PD-L1-high (≥50%), stage IIIB-IV NSCLC. MATERIALS AND METHODS: This phase 2, multicenter, randomized, open-label study (ARC-10, Part 1) randomized (2:2:1) patients to intravenous domvanalimab 15 mg/kg plus zimberelimab 360 mg (DZ), zimberelimab 360 mg (Z), or platinum-doublet chemotherapy every 3 weeks. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), confirmed objective response rate (ORR), and safety. RESULTS: Of 98 randomized patients, 95 received treatment (DZ, n = 38; Z, n = 40; chemotherapy, n = 17). As of May 17, 2024, median follow-up was 24.5 months; 22patients remained on first-line treatment (DZ, n = 11; Z, n = 10; chemotherapy, n = 1). Median (95% CI) PFS was 11.5 (4.0-26.2) months for DZ, 6.2 (2.5-12.3) months for Z, and 9.6 (2.6-16.4) months for chemotherapy. Median (95% CI) OS was not reached (13.7-not evaluable [NE]) for DZ, 24.4(7.8-NE) months for Z, and 11.9(2.7-NE) months for chemotherapy. DZ vs Z hazard ratio (95% CI) was 0.69 (0.40-1.18) for PFS and 0.64 (0.32-1.25) for OS. ORR (95% CI) was 44.7% (28.6-61.7) for DZ, 35.0% (20.6-51.7) for Z, and 35.3% (14.2-61.7) for chemotherapy. Grade ≥ 3 treatment-related adverse events (AEs) were lower for DZ (21.1%) and Z (15.0%) vs chemotherapy (47.1%). Immune-mediated AEs were similar between DZ (23.7%) and Z (20.0%). Infusion-related reactions were low (0%-7.9% across arms). CONCLUSIONS: Adding Fc-silent anti-TIGIT (domvanalimab) to anti-PD-1 (zimberelimab) led to encouraging efficacy and showed no new safety concerns in patients with previously untreated stage IIIB-IV NSCLC.
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