BeyondSpring announced the first patient has been treated in an investigator-initiated, open-label Phase 2 study with lead asset plinabulin in combination with nivolumab + ipilimumab in patients with 3rd line recurrent small-cell lung cancer (SCLC) who failed checkpoint inhibitors and platinum-based chemotherapy. Plinabulin is a selective immunomodulating microtubule-binding agent (SIMBA), which is a potent antigen presenting cell (APC) inducer. This Phase 2 study, to be conducted through the Big Ten Cancer Research Consortium in 7 U.S. clinical centers, comes after the successful completion of the Phase 1 dose escalation study portion of this Phase 1/2 study. In this Phase 2 study, up to 26 patients with histological or cytological confirmed extensive-stage SCLC who progressed after at least one platinum-based chemotherapy regimen and checkpoint inhibitors will receive the triple combination of plinabulin + nivolumab + ipilimumab. Patients in the Phase 2 study will continue treatment until disease progression, development of unacceptable toxicity, or one of the protocol-defined reasons for treatment discontinuation occurs. SCLC Phase 1 IIT Study (Big Ten Consortium): In the Phase 1 dose escalation study evaluating 20 mg/m2 and 30 mg/m2 doses of plinabulin combined with nivolumab and ipilimumab in 16 patients, the 30 mg/m2 dose was selected for the Phase 2 trial. All 16 patients were evaluated for safety, and 13 patients were evaluated for efficacy. The combination demonstrated favorable safety and tolerability. There were no Grade 4 events in the 16 patients studied, and 12.5% experienced Grade 3 IR-AEs, compared to 37% Grade 3/4 IR-AEs reported with nivolumab + ipilimumab in SCLC. ORR was 50% for the six patients receiving the triple IO combination as second line therapy after platinum. Three patients had partial responses (PR), with best tumor reduction at target lesions of 100%, 53% and 45%, respectively. ORR was 43% for the seven patients receiving the triple IO combination as third line therapy, who had either failed or had not responded to platinum and PD-1/PD-L1 inhibitors. Three patients had PRs, with best tumor reductions at target lesions of 78%, 75% and 52%, respectively. Duration of therapy for these 3 PR patients was 18 months, five months (still on treatment) and three months, respectively.