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Mini Oral - NSCLC, metastatic

LBA58 - ORR in patients receiving nivolumab plus radiotherapy in advanced non-small cell lung cancer: First results from the FORCE trial


18 Sep 2020


Mini Oral - NSCLC, metastatic



Tumour Site

Non-Small Cell Lung Cancer


Farastuk Bozorgmehr


Annals of Oncology (2020) 31 (suppl_4): S1142-S1215. 10.1016/annonc/annonc325


F. Bozorgmehr1, J.R. Fischer2, M. Bischof3, A. Atmaca4, S. Wetzel5, M. Faehling6, D. Bottke7, M. Wermke8, E.G..C. Troost9, G. Schmidtke-Schrezenmeier10, T. Wiegel11, V. van Laak12, A. Stupavsky13, W. Engel-Riedel14, E. Ingenhoff15, N. Reinmuth16, J. Krisam17, A. Stenzinger18, M. Thomas1, S. Rieken19

Author affiliations

  • 1 Department Of Thoracic Oncology, Thoraxklinik Heidelberg, 69126 - Heidelberg/DE
  • 2 Department Of Thoracic Oncology, Lungenklinik Löwenstein, 74245 - Löwenstein/DE
  • 3 Department Of Radiation Oncology, Klinikum am Gesundbrunnen, SLK-Kliniken Heilbronn GmbH, 74078 - Heilbronn/DE
  • 4 Klinik Für Onkologie Und Hämtologie, Nordwest-Krankenhaus, 60488 - Frankfurt am Main/DE
  • 5 Department Of Radiation Oncology, Krankenhaus Nordwest, 60488 - Frankfurt/DE
  • 6 Klinik Für Kardiologie Und Pneumologie, Klinikum Esslingen, 73730 - Esslingen am Neckar/DE
  • 7 Department Of Radiation Oncology, MVZ Hospital Esslingen, 73730 - Esslingen/DE
  • 8 Nct/ucc Early Clinical Trial Unit, Universitätsklinikum Carl Gustav Carus, 01307 - Dresden/DE
  • 9 Department Of Radiotherapy And Radiation Oncology, Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, 01307 - Dresden/DE
  • 10 Department Of Pneumology, University Hospital Ulm, 89081 - Ulm/DE
  • 11 Department Of Radiotherapy And Radiation Oncology, University Hospital Ulm, 89081 - Ulm/DE
  • 12 Department Of Internal Medicine, Pneumology And Sleep Medicine, DRK Kliniken Berlin Mitte, 13359 - Berlin/DE
  • 13 Department Of Radiation Oncology, DRK Kliniken Berlin Westend, 14050 - Berlin/DE
  • 14 Lungenklinik, Krankenhaus Merheim, 51109 - Köln/DE
  • 15 Department Of Radiation Oncology, City of Cologne Municipal Hospitals, 51109 - Cologne/DE
  • 16 Thoracic Oncology Department, Asklepios Fachkliniken München-Gauting, 82131 - Munich-Gauting/DE
  • 17 Institute Of Medical Biometry And Informatics, University of Heidelberg, 69120 - Heidelberg/DE
  • 18 Institute Of Pathology, Heidelberg University Hospital, 69120 - Heidelberg/DE
  • 19 Department Of Radiation Oncology, Heidelberg University Hospital, 69120 - Heidelberg/DE


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Abstract LBA58


The FORCE trial addressed the hypothesis that applying radiation together with anti-PD-1 immunotherapies may foster immune response, by combining nivolumab and radiation in non-small cell lung cancer (NSCLC) patients with clinical indication for radiotherapy.


From 02/17-12/19, 101 patients with stage IV non-squamous NSCLC in 2nd-line or 3rd-line treatment were enrolled in this multicentre, prospective, non-randomized phase II trial. 41 patients with a clinical indication for palliative radiotherapy received nivolumab 240 mg followed by 5 x 4 Gy on consecutive days to metastasis (53% bone, 18% lymph node, 29% other), initiated 72 hours after first nivolumab administration (Group A). 60 patients without an indication for radiotherapy received nivolumab only (Group B). Nivolumab was administered every two weeks in both groups and continued until progression or limiting toxicities. In both groups, biomaterials were collected systematically for exploratory hypothesis-generating analyses.


Whilst some patient baseline characteristics, e.g. age, gender, smoking status and number of previous therapies were similar in both groups, preliminary analyses indicate an imbalance with a number of unfavourable characteristics being more prevalent in group A (e.g. ECOG 1, 81% vs 58%; extrathoracic metastases, 93% vs. 63%; p<0.05). Treatment related grade 3-4 adverse events occurred at similar rates in both groups (17% vs. 15%, p=0.8). The primary objective was to achieve an objective response rate (ORR) of > 19% per RECIST criteria 1.1 in group A. With an ORR of 8.3% in group A, this target was not met (p=0.991 for one-sided binomial test). ORR in group B was 23.8%. Patients with missing tumor response assessment due to tumor-related death (group A and B: 8 and 5) were considered non-responders.


The combination of nivolumab and palliative radiotherapy was safe and feasible; however, it did not improve ORR in the setting of this exploration. The requirement for a clinical indication for palliative radiotherapy enforced selection of patients with unfavourable properties into group A. Clinical characteristics need consideration when assessing the efficacy of immunotherapy.

Clinical trial identification

EudraCT Nr.: 2015-005741-3; NCT03044626.

Editorial acknowledgement

Legal entity responsible for the study

AIO-Studien gGmbH.


Bristol Myers Squibb.


F. Bozorgmehr: Research grant/Funding (self): BMS; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): AstraZeneca; Honoraria (self), Research grant/Funding (institution): Roche; Honoraria (self): Novartis; Honoraria (self): MSD; Honoraria (self): Chugai. A. Atmaca: Advisory/Consultancy: BMS; Advisory/Consultancy: Roche; Advisory/Consultancy: MSD; Advisory/Consultancy: AstraZeneca. M. Faehling: Honoraria (self), Advisory/Consultancy: BMS; Honoraria (self), Advisory/Consultancy: MSD; Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Advisory/Consultancy: AstraZeneca. N. Reinmuth: Honoraria (self), Advisory/Consultancy: BMS. A. Stenzinger: Advisory/Consultancy, Speaker Bureau/Expert testimony: AstraZeneca; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Bayer; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (self): BMS; Advisory/Consultancy, Speaker Bureau/Expert testimony: Eli Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony: Illumina; Advisory/Consultancy, Speaker Bureau/Expert testimony: Janssen; Advisory/Consultancy, Speaker Bureau/Expert testimony: MSD; Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis; Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer; Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche; Advisory/Consultancy, Speaker Bureau/Expert testimony: Seattle Genetics; Advisory/Consultancy, Speaker Bureau/Expert testimony: Takeda; Advisory/Consultancy, Speaker Bureau/Expert testimony: ThermoFischer; Research grant/Funding (institution): Chugai. M. Thomas: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Boehringer Ingelheim; Honoraria (self), Travel/Accommodation/Expenses: Celgene; Honoraria (self), Travel/Accommodation/Expenses: Chugai; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Lilly; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: MSD; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Novartis; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Takeda. All other authors have declared no conflicts of interest.

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