Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the impact of immunotherapy in squamous non—small cell lung cancer (NSCLC).

In this patient population, the addition of immunotherapy has significantly improved response rates from what was previously seen with chemotherapy alone, Nadler says. Overall survival (OS) is being prolonged in unprecedented fashion, even when immunotherapy is used as second-line treatment. However, it appears that giving chemoimmunotherapy in the frontline setting is more effective because not all patients are fit enough to receive immunotherapy in the second-line setting, Nadler notes.

It may seem as though immunotherapy is readily available, but recent data show not all patients can get it in the second-line setting. Moreover, the benefit with immunotherapy is seen across PD-L1 subgroups. While the progression-free survival in the PD-L1—negative group is not impressive by itself, there is a clear OS benefit in that population, says Nadler.

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Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the impact of immunotherapy in squamous non–small cell lung cancer.

Dr. Nadler on the Impact of Immunotherapy in Squamous NSCLC

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the IMpower131 study in stage IV squamous non—small cell lung cancer (NSCLC).

The IMpower131 trial was designed similarly to that of the KEYNOTE-407 study except that patients receiving carboplatin were randomized to either paclitaxel or nab-paclitaxel (Abraxane). The other difference between IMpower131 and KEYNOTE-407—–the study that led to the FDA approval of pembrolizumab (Keytruda) plus chemotherapy in this setting––was that patients weren’t allowed to crossover. These patients were able to receive second-line immunotherapy, Nadler notes.

Moreover, patients experienced a benefit in progression-free and overall survival benefit with the addition of atezolizumab (Tecentriq) in IMpower131. However, PD-L1 nonexpressers did not do quite as well with chemoimmunotherapy; the response rates were lower. Nadler notes that patients with PD-L1 less than 1% tend to derive less benefit from immunotherapy. Atezolizumab plus carboplatin and paclitaxel/nab-paclitaxel is not yet FDA approved or used routinely, but more mature data may change that, says Nadler.

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the IMpower131 study in squamous metastatic non–small cell lung cancer.

Dr. Nadler Discusses the IMpower131 Study in Squamous NSCLC

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the role of PD-L1 in patients with squamous non—small cell lung cancer (NSCLC).

Benefit from the combination of pembrolizumab (Keytruda) plus carboplatin and paclitaxel/nab-paclitaxel (Abraxane) may be markedly different in patients with low versus high levels of PD-L1 expression. However, Nadler notes, every patient with metastatic squamous NSCLC should receive this regimen in the frontline setting regardless of PD-L1 status. In October 2018, the FDA approved the regimen in the frontline setting. The choice of whether to administer paclitaxel or nab-paclitaxel is up to the discretion of the treating physician, adds Nadler.

As more data emerge looking at the role of tumor mutational burden in predicting immunotherapy response, it may become apparent that some patients with low PD-L1 expression should not receive this regimen upfront. For the time being, every patient should be treated with this regimen. Though, it is unclear if that will continue to be the case moving forward, Nadler concludes.

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the role of PD-L1 in patients with squamous non–small cell lung cancer.

Eric S. Nadler, MD

Articles

Dr. Nadler on the Impact of Immunotherapy in Squamous NSCLC

Dr. Nadler Discusses the IMpower131 Study in Squamous NSCLC

Dr. Nadler Discusses Role of PD-L1 in Squamous NSCLC