NADINA
Giving the immunotherapy doublet before surgery, instead of nivolumab after, cut the risk of recurrence by about two thirds and let most patients skip further treatment.
Presented at the ASCO 2024 plenary and published in NEJM (June 2024). 12-month EFS 83.7% vs 57.2%; HR for progression, recurrence or death 0.32. Around 59% of the neoadjuvant arm had a major pathological response and received no adjuvant therapy. The first phase 3 in oncology to test an immunotherapy-only neoadjuvant regimen against standard of care; adopted into NCCN and ESMO guidance as a preferred option for resectable nodal disease.
- 83.7 vs 57.2 out of 100 free of a major event at 12 months with Neoadjuvant ipilimumab + nivolumab compared with Adjuvant nivolumab; 26.5 more per 100.
- Roughly one extra person helped for every 4 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Put another way, the treated group had about 68 percent lower chance of the event at any given time (hazard ratio 0.32).
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- These results apply to the people the trial enrolled: Resectable macroscopic stage III melanoma: two cycles neoadjuvant ipilimumab + nivolumab then surgery (adjuvant only if incomplete response) vs surgery then 12 cycles adjuvant nivolumab. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
423 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Event-free survival at 12 monthsprimary | Neoadjuvant ipilimumab + nivolumab | — | 83.7% | 0.32 | — | link |
| Adjuvant nivolumab | — | 57.2% |
Pages like this
not linked directly; found by shared links- Key paperNADINA: two doses of ipilimumab plus nivolumab before surgery beat a year of nivolumab after surgery in stage III melanoma
Shares Christian Blank, Event-free / disease-free survival (EFS, DFS, iDFS, RFS), Netherlands Cancer Institute (NKI-AvL), CTLA-4.
- IdeaTreat the draining lymph node before removing it
Shares Major pathological response (MPR), Christian Blank, Ipilimumab, Nivolumab.
- TrialSWOG S1801
Shares Neoadjuvant immunotherapy → response-adapted adjuvant, Neoadjuvant / adjuvant / perioperative, PD-1, Melanoma.
- TrialCheckMate 648
Shares CTLA-4, Ipilimumab, Nivolumab, PD-1.
- TrialCheckMate 9DW
Shares CTLA-4, Ipilimumab, Nivolumab, PD-1.
- TrialNICHE-2
Shares Use pre-surgery immunotherapy windows as the field's biomarker engine, Netherlands Cancer Institute (NKI-AvL), Neoadjuvant / adjuvant / perioperative, Ipilimumab.
- InstitutionDartmouth Cancer Center
Shares CTLA-4, Ipilimumab, Nivolumab, PD-1.
- TrialDREAMseq (ECOG-ACRIN EA6134)
Shares CTLA-4, Ipilimumab, Nivolumab, PD-1.