The Absolute Effect / Oncology Evidence / Evidence Index
CheckMate 227
In first-line metastatic NSCLC without sensitizing EGFR/ALK alterations, does nivolumab plus ipilimumab improve long-term survival over platinum chemotherapy across PD-L1 strata?
Registry: NCT02477826 · Evidence reviewed 9 November 2026 · Aliases and follow-up publications consolidated.
Phase III multi-part randomized trial; Part 1 n=1,739.Primary-source evidence summaryStudy design, population and eligibility
Phase III multi-part randomized trial; Part 1 n=1,739.
Stage IV/recurrent NSCLC without sensitizing EGFR/ALK; PD-L1 strata included.
Treatment and comparator
Intervention: Nivolumab + ipilimumab.
Comparator: Platinum-doublet chemotherapy; additional nivolumab-containing arms were studied.
Endpoints
OS in PD-L1 ≥1% primary comparison; long-term OS reported across strata.
Key efficacy and clinical outcomes
At ≥61.3-mo follow-up 5-y OS nivo/ipi vs chemo: 24% vs 14% for PD-L1≥1%; 19% vs 7% for PD-L1<1%.
Source-reported outcome visualization
Values are reproduced from the cited report; bars are scaled within this figure. First-line stage IV/recurrent NSCLC without sensitizing EGFR/ALK
Median survival and hazard ratios are not fixed-time event risks; NNT is not inferred from them.
Toxicity and treatment burden
Dual checkpoint blockade causes immune-mediated colitis, hepatitis, pneumonitis and endocrinopathy.
Absolute effect and NNT/NNH
Multi-part trial with multiple comparisons; page focuses on nivo/ipi vs chemo. Distinct from CheckMate 9LA.
NNT/NNH is not calculated unless a directly reported, comparable fixed-time risk difference supports it. Median survival and hazard ratios alone do not provide an NNT.
Critical interpretation and limitations
Multi-part trial with multiple comparisons; page focuses on nivo/ipi vs chemo. Distinct from CheckMate 9LA.
This page is an evidence summary, not a substitute for multidisciplinary assessment or patient-specific decision-making.
Current-practice context
Review date: 9 November 2026. Primary publication and selected follow-up sources were reviewed. Full disease-specific guideline, regulatory-label and sequencing audit remains pending; verify current local recommendations and biomarker eligibility before clinical application.