David P. Carbone, MD, PhD, director of the Thoracic Oncology Center; a professor in the Division of Medical Oncology; co-leader of the Translational Therapeutics Program; and Barbara J. Bonner Chair in Lung Cancer Research, at The Ohio State University Comprehensive Cancer Center—James, discusses the impact of immunotherapy on lung cancer.

The outcome of studies evaluating immunotherapy has transformed the prospects for lung cancer in the past few years, says Carbone. Patients used to be told that metastatic lung cancer was incurable but treatable. Now, studies are demonstrating that some of the early patients who were treated with this approach 5 to 7 years ago are still free of relapse, which is an incredible advance over the past few years, says Carbone. Approximately 20% of patients treated in the first-line setting are alive and free of disease progression at 5 or 6 years, and that was never seen before with chemotherapy.

With the chemoimmunotherapy and double immunotherapy approaches that are currently under exploration, the survival of these patients may be improved even further, Carbone adds. Hopefully, markers for patients can be identified to select them better for this treatment, similar to what the field has seen with targeted therapies. Instead of 20% of patients being alive at 5 years, perhaps the field will see 80% of patients alive at that time point because of better patient selection; this could also save patients unnecessary toxicity and costs of ineffective therapies, concludes Carbone.

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David P. Carbone, MD, PhD, discusses the impact of immunotherapy on lung cancer.

Dr. Carbone on the Impact of Immunotherapy in Lung Cancer

David P. Carbone, MD, PhD, director of the Thoracic Oncology Center; a professor in the Division of Medical Oncology; co-leader of the Translational Therapeutics Program; and Barbara J. Bonner Chair in Lung Cancer Research, at The Ohio State University Comprehensive Cancer Center–James, discusses the impact of immunotherapy on lung cancer.

David P. Carbone, MD, PhD, director of the Thoracic Oncology Center; a professor in the Division of Medical Oncology; co-leader of the Translational Therapeutics Program; and Barbara J. Bonner Chair in Lung Cancer Research, at The Ohio State University Comprehensive Cancer Center—James, discusses the importance of personalizing immunotherapy for patients with non–small cell lung cancer (NSCLC).

The role of precision medicine has seen rapid progress in lung cancer, says Carbone. The field continues to move toward matching individual patients with targeted therapies based on biomarkers.

However, the high response rates that have been seen with immunotherapy in lung cancer poses the risk of reverting to a one-size-fits-all treatment approach where all patients receive the same immunotherapeutic regimen, explains Carbone.

It is important to select which patients should receive immunotherapy based on their likelihood of response, says Carbone. Research in this regard could shed light on novel therapies or combinations that could have utility in specific patient populations, concludes Carbone.

David P. Carbone, MD, PhD, discusses the importance of personalizing immunotherapy for patients with non–small cell lung cancer.

Dr. Carbone on the Importance of Personalizing Immunotherapy in NSCLC

David P. Carbone, MD, PhD, director of the Thoracic Oncology Center; a professor in the Division of Medical Oncology; co-leader of the Translational Therapeutics Program; and Barbara J. Bonner Chair in Lung Cancer Research, at The Ohio State University Comprehensive Cancer Center—The James, discusses a study evaluating acquired resistance to osimertinib (Tagrisso) in non–small cell lung cancer (NSCLC).

A retrospective multicenter study of lung cancer patients who developed resistance to osimertinib was conducted. Genomic profiling was performed for all patients through the use of targeted next-generation sequencing that encompassed 59-1021 cancer-related genes. All of the patients in that study had 

 mutations and were treated with TKIs, but it is a mystery why some patients experienced very short responses, while others experienced very long responses, says Carbone. Specifically, some responses lasted for just a few months, while others persisted for many years.

One question raised by this study has to do with why the tumor becomes resistant after these therapies, adds Carbone. The goal of that study was to investigate the mutational landscape of these tumors and try and associate which mutations occur along with the 

 mutation, or arise as a consequence of the resistance, and might be contributing to this very ability, concludes Carbone.

David P. Carbone, MD, PhD, discusses a study evaluating acquired resistance to osimertinib in non–small cell lung cancer.

Dr. Carbone on Acquired Resistance to Osimertinib in NSCLC

David P. Carbone, MD, PhD, director of the Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center—James, provides perspective on the novel coronavirus 2019 (COVID-19).

Patients with lung cancer are at an increased risk of developing severe complications from COVID-19, says Carbone. Patients are at even further risk of contracting the virus when they go to a cancer center or clinic for treatment because they could be exposed, adds Carbone.

Community spread has caused a rapid increase in the number of confirmed cases in the United States. As such, patients should take precautionary measures, such as hand washing and social distancing to reduce potential exposure to the virus. By studying the disease, immunologists hope to develop a vaccine to prevent the spread of the virus. However, in order to curb the spread of COVID-19, people will have to take the vaccine, which has been one of the ongoing struggles with the influenza vaccine, concludes Carbone.

*This interview took place March 11, 2020

David P. Carbone, MD, PhD, director of the Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center–James, provides perspective on the novel coronavirus 2019 (COVID-19).

Dr. Carbone Provides Perspective on COVID-19

David P. Carbone, MD, PhD, a professor in the Division of Medical Oncology at the Ohio State University Comprehensive Cancer Center, discusses potential biomarkers in lung cancer.

Since both anti-PD-1 and anti-PD-L1 are targeting specific receptors or ligands, Carbone says, the expression of these targets are candidate biomarkers. The best data is on the tumor expression of PD-L1.

Carbone says the majority of responses occur in patients with immunohistochemical evidence of expression. However, as with any immunohistochemical test, it is antibody-dependent and variable. As in most studies, there are some responses in patients who are negative, Carbone says, which could be an assay problem.

Carbone says physicians do not seem to be ready to exclude PD-L1-negative patients. Given the limited number of options in lung cancer, the option of excluding patients from therapy by lack of immunohistochemical positivity is still experimental, Carbone says, but it i the best candidate biomarker that exists.

Dr. Carbone on Potential Biomarkers in Lung Cancer

David P. Carbone, MD, PhD, a professor in the Division of Medical Oncology at the Ohio State University Comprehensive Cancer Center, discusses the exploration of immunotherapies as treatments for patients with advanced lung cancer.

The efficacy of immunotherapy in lung cancer represent the most exciting advancment in this space within the past few years, Carbone states. Prior to this, the greatest advance was next generation sequencing and the discovery of actionable mutations, such as 

A large majority of patients with lung cancer do not have an immediately actionable mutation. In these patients, immunotherapy may elicited a durable and effective response. Additionally, combinations of immunotherapy and EGFR- or ALK-targeted therapy could further improve outcomes, Carbone believes.

David P. Carbone, MD, PhD, from the Ohio State University Comprehensive Cancer Center, discusses the exploration of immunotherapies as treatments for patients with advanced lung cancer. 


Dr. Carbone on Immunotherapy Research in Lung Cancer

David P. Carbone, MD, PhD, a professor in the Division of Medical Oncology at the Ohio State University Comprehensive Cancer Center, describes variations in the accuracy and availability of genetic testing technologies for patients with lung cancer.

Across the country, there is not only uneven access to genetic testing but also variations in accuracy, explains Carbone. Each test for EGFR is not the same, since some exclude rare mutations. As such, there is currently a transition under way in genetic testing with a potential transition to next-generation sequencing in the future.

Despite this transition, immunohistochemistry may be a better approach in some situations, since it can focus more on the protein. The ideal test, Carbone notes, would focus on the protein, since this is generally what is targeted by treatment. However, Carbone adds, at this point, protein-specific data and tests are less developed than genetic testing.

David P. Carbone, MD, PhD, from the Ohio State University Comprehensive Cancer Center, describes variations in the accuracy and availability of genetic testing technologies.

David P. Carbone, MD, PhD

Articles

Dr. Carbone on the Impact of Immunotherapy in Lung Cancer

Dr. Carbone on the Impact of Immunotherapy in Lung Cancer

Dr. Carbone on the Importance of Personalizing Immunotherapy in NSCLC

Dr. Carbone on Acquired Resistance to Osimertinib in NSCLC

Dr. Carbone Provides Perspective on COVID-19

Dr. Carbone on Potential Biomarkers in Lung Cancer

Dr. Carbone on Immunotherapy Research in Lung Cancer

Dr. Carbone on Genetic Testing Availability and Accuracy