Jyoti D. Patel, MD, professor of medicine, director, Thoracic Oncology, University of Chicago Medicine, discusses the results of the CheckMate-227 trial, which looked at an immunotherapy combination versus chemotherapy in patients with advanced non—small cell lung cancer.

At the 2019 ESMO Congress, a presentation on the CheckMate-227 trial showed the comparison between nivolumab (Opdivo) and ipilimumab (Yervoy) and chemotherapy alone, explains Patel. The immunotherapy combination reached statistical significance in patients with PD-L1 tumor proportion score >1%. Patients who did not have PD-L1 expression also benefited substantially from the nivolumab/ipilimumab regimen, according to Patel.

A significant number of complete responses with the combination were observed and the toxicity was well managed. These results will benefit patients who prefer a chemotherapy-free backbone, says Patel. Next, research must determine how to select patients for the immunotherapy doublet, concludes Patel.

Videos

Jyoti D. Patel, MD, discusses the results of the CheckMate-227 trial, which looked at an immunotherapy combination versus chemotherapy in patients with advanced non–small cell lung cancer.

Dr. Patel on CheckMate-227 Results in Advanced NSCLC

Jyoti D. Patel, MD, professor of medicine, director, Thoracic Oncology, University of Chicago Medicine, discusses immunotherapy combinations for patients with advanced nonsquamous non—small cell lung cancer.

In the absence of a driver mutation, immunotherapy can be given alone or in combination with chemotherapy, explains Patel. Patients with a PD-L1 tumor proportion score (TPS) ≥50% by immunohistochemistry could receive pembrolizumab (Keytruda) alone. For patients with a PD-L1 TPS <50%, the combination of chemotherapy and immunotherapy is recommended, according to Patel.

Data from the phase III KEYNOTE-189 trial established the combination of pembrolizumab, pemetrexed (Alimta), and platinum chemotherapy as a frontline standard of care in patients with metastatic nonsquamous NSCLC without 

 alterations. The triplet regimen showed an improvement in response rates, progression-free survival, and overall survival (OS) versus placebo/chemotherapy. An updated analysis of the KEYNOTE-189 showed that the addition of pembrolizumab to chemotherapy demonstrated a 44% reduction in the risk of death versus chemotherapy alone (HR, 0.56; 95% CI, 0.45-0.70;

In the phase III IMpower150 trial, investigators evaluated carboplatin, paclitaxel, bevacizumab (Avastin), and atezolizumab (Tecentriq) in patients with metastatic nonsquamous NSCLC who had not received chemotherapy. There is scientific rationale for the combination of chemotherapy and immunotherapy, says Patel. The combination increases neoantigen presentation and results in a more favorable immune environment. The addition of bevacizumab inhibits the VEGF pathway, which improves dendritic cell function and leads to a synergistic benefit with the quadruplet therapy, concludes Patel.

Jyoti D. Patel, MD, discusses immunotherapy combinations for patients with advanced nonsquamous non–small cell lung cancer.

Dr. Patel on Immunotherapy Combinations in Lung Cancer

Jyoti D. Patel, MD, professor of medicine, director, Thoracic Oncology, University of Chicago Medicine, discusses current immunotherapy options in stage IV non—small cell lung cancer (NSCLC). 

 are actionable targets for patients with advanced NSCLC. Additional targets such as 

 are emerging; however, the majority of patients do not harbor an actionable target, says Patel. 

Patients who do not harbor an actionable target generally receive frontline immunotherapy. The decision comes down to whether to use immunotherapy alone or with a chemotherapy backbone. Factors that are taken into consideration include biology, tumor markers, disease burden, and patient preference, concludes Patel. 

Jyoti D. Patel, MD, discusses current immunotherapy options in stage IV non–small cell lung cancer. 

Dr. Patel on Immunotherapy Landscape of Stage IV NSCLC

Jyoti D. Patel, MD, professor of medicine, director of thoracic oncology, the University of Chicago Medicine, discusses the FDA approval of durvalumab (Imfinzi) in patients with non—small cell lung cancer (NSCLC).

Jyoti D. Patel, MD, professor of medicine, director of thoracic oncology, the University of Chicago Medicine, discusses the FDA approval of durvalumab (Imfinzi) in patients with non

Dr. Patel on the FDA Approval of Durvalumab in NSCLC

Jyoti D. Patel, MD, thoracic oncologist, Northwestern University Feinberg School of Medicine, discusses the benefits of multidisciplinary approach for the treatment of patients with stage III disease.

All patients with stage III disease will receive chemotherapy, Patel says, and their medical oncologist will guide them through the process. There needs to be a conversation with a radiation oncologist regarding heart and lung toxicity and a conversation with a surgeon regarding resection.

View more from the 2014 Multidisciplinary Symposium in Thoracic Oncology

Dr. Patel on the Benefits of a Multidisciplinary Approach for Patients With Stage III Lung Cancer

Jyoti D. Patel, MD, ASCO expert, associate professor, Northwestern University Feinberg School of Medicine, discusses a phase II trial that looked at olaparib in combination with cediranib versus olaparib alone in recurrent platinum-sensitive ovarian cancer. This trial was presented by Dr. Joyce Liu at the 2014 ASCO Annual Meeting.

In this trial, patients treated with the combination of olaparib and cediranib saw a near doubling in progression-free survival compared with those patients receiving olaparib alone (17.7 months and 9.0 months, respectively).

These patients with recurrent ovarian cancer often experience debilitating symptoms, Patel says, so this combination elicited a significant quality of life benefit. There was, however, more toxicity with the combination, including hypertension, rash, and fatigue.

Results from this trial are compelling and the combination will be explored in a phase III trial.

Jyoti D. Patel, MD, discusses a phase II trial that looked at olaparib in combination with cediranib versus olaparib alone in recurrent platinum-sensitive ovarian cancer.

Jyoti D. Patel, MD

Articles

Dr. Patel on CheckMate-227 Results in Advanced NSCLC

Dr. Patel on Immunotherapy Combinations in Lung Cancer

Dr. Patel on Immunotherapy Landscape of Stage IV NSCLC

Dr. Patel on the FDA Approval of Durvalumab in NSCLC

Dr. Patel on the Benefits of a Multidisciplinary Approach for Patients With Stage III Lung Cancer

Dr. Patel on an Analysis of Olaparib and Cediranib for Ovarian Cancer