ATTRACTION-2
ATTRACTION-2 was the first randomised trial to show that an immunotherapy drug, nivolumab, helps people with heavily pretreated stomach cancer live longer than placebo, and it made nivolumab a late-line option in East Asia before any Western approval.
Overview
ATTRACTION-2 was a double-blind phase 3 trial run by Ono Pharmaceutical across Japan, South Korea and Taiwan in patients with unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer that had progressed after two or more chemotherapy regimens. Patients were randomised two to one to nivolumab or placebo; PD-L1 expression was not required and was analysed afterwards.
Nivolumab prolonged overall survival compared with placebo, the primary endpoint, and the benefit held in longer follow-up. The result led to approval of nivolumab for previously treated gastric cancer in Japan in September 2017, the first checkpoint inhibitor approval in this disease, and it seeded the first-line chemo-immunotherapy trials that followed (ATTRACTION-4 and CheckMate 649).
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