Article
作者: Wan, Lixin ; Ba, Yi ; Liu, Zhenyang ; Pan, Hongming ; Yao, Zhifang ; Guo, Zengqing ; Li, Baiyong ; Chen, Ye ; Wang, Meiqing ; Liu, Bo ; Li, Changzheng ; Xu, Nong ; Hu, Mingxiu ; Zhang, Tao ; Zhang, Futong ; Zhang, Jinghua ; Zhang, Xiaotian ; Zhou, Yongjian ; Wang, Zejun ; Li, Wei ; Xia, Michelle ; Liu, Ming ; Zhang, Jingdong ; Yu, Guohua ; Qu, Xiujuan ; Wang, Ying ; Jin, Jianying ; Sheng, Lili ; Li, Ning ; Gu, Kangsheng ; Zhang, Ruixing ; Bai, Yuansong ; Li, Wenxin ; Liu, Wei ; Xu, Jiye ; Xu, Huiting ; Xu, Hongyan ; Chen, Hao ; Zhuang, Zhixiang ; Pardoll, Drew M ; Nie, Peng ; Gao, Xiangyu ; Guo, Jun ; Zhao, Xuehong ; Huang, Mingwei ; Xie, Ming ; Yuan, Yuan ; Qiu, Wensheng ; Wang, Yusheng ; Zhang, Jiajia ; Zhao, Jun ; Zeng, Shan ; Wu, Guowu ; Wang, Zhongmin Maxwell ; Lu, Dongmei ; Tang, Yong ; Liu, Haiyan ; Wang, Weibo ; Zang, Aimin ; He, Yifu ; Liu, Zheng ; Ying, Xiangji ; Wei, Jia ; Wang, Zhenghua ; Huang, Mingzhu ; Zhang, Yanqiao ; Lin, Lizhu ; Zhang, Xizhi ; Sun, Shujuan ; Li, Xiaoqin ; Gao, Yong ; Zheng, Zhendong ; Wang, Daqing ; Fang, Xuefeng ; Ji, Jiafu ; Xie, Lin ; Li, Ziyu ; Liu, Lian ; Li, Qingshan ; Dai, Wenxiang ; Shen, Lin ; Ying, Jieer ; Zhang, Minghui ; Kang, Mafei ; Cao, Bangwei ; Chen, Jian ; Liu, Mulin ; Liu, Hao ; Fu, Yang ; Zhong, Diansheng
Programmed cell death protein-1 (PD-1) inhibitors plus chemotherapy have been the standard of care in the first-line treatment of advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma; however, the survival benefits are modest in patients with low programmed death ligand 1 (PD-L1) expression. Here we investigated the efficacy and safety of cadonilimab (PD-1/cytotoxic T lymphocyte antigen-4 (CTLA-4) bispecific antibody) plus chemotherapy as first-line treatment in G/GEJ adenocarcinoma. The prespecified interim analysis is reported here. This was a randomized, double-blind, placebo-controlled phase 3 study. Eligible patients were adults with untreated, unresectable, locally advanced or metastatic G/GEJ adenocarcinoma. Patients were randomized 1:1 to receive cadonilimab (10 mg kg-1 every 3 weeks) or placebo plus chemotherapy (every 3 weeks). The primary endpoint was overall survival (OS) in the intention-to-treat population (one-sided significance level, P = 0.025). Secondary endpoints included OS in patients with a PD-L1 combined positive score ≥5, progression-free survival, objective response rate, duration of response and safety. As of 18 August 2023, 610 patients from 75 study centers were randomized to cadonilimab (n = 305) or placebo (n = 305). With a median follow-up of 18.7 months, the cadonilimab group had a significantly longer median OS (14.1 versus 11.1 months; hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.54-0.81; P < 0.001) than the placebo group. The primary endpoint was met. The median progression-free survival was 7.0 months versus 5.3 months (HR 0.53, 95% CI 0.44-0.65). The median OS in patients with a PD-L1 combined positive score ≥5 was 15.3 months versus 10.9 months (HR 0.58, 95% CI 0.41-0.82). The objective response rate was 65.2% versus 48.9% with a median duration of response of 8.8 months versus 4.4 months. Grade ≥3 treatment-related adverse events occurred in 65.9% of the cadonilimab group and 53.6% of the placebo group, and the most common were decreased platelet count, decreased neutrophil count and anemia. Most of the immune-related adverse events were grade 1 or 2. No new safety signals were observed. Cadonilimab plus chemotherapy significantly improved OS with a manageable safety profile in patients with advanced G/GEJ adenocarcinoma. ClinicalTrials.gov registration: NCT05008783 .