Nir Peled, MD, PhD, FCCP, head of the European Respiratory Society Thoracic Oncology Assembly, head of the Thoracic Cancer Unit at the Center of Precision Cancer Care of Davidoff Cancer Center, and an associate professor, the Sackler Faculty of Medicine at Tel Aviv University, discusses the rationale of evaluating the combination of lenvatinib (Lenvima) and pembrolizumab (Keytruda) plus chemotherapy in non–small cell lung cancer (NSCLC).

The global, randomized, double-blind, placebo-controlled, phase 3 LEAP-006 trial (NCT03829319) is evaluating pembrolizumab plus platinum-based chemotherapy, with or without lenvatinib, in patients with previously untreated metastatic nonsquamous NSCLC.

Lenvatinib is a TKI inhibitor that targets both vascular and epithelial mechanisms, and the combination of lenvatinib plus pembrolizumab has been approved for the treatment of some carcinomas after eliciting promising responses, Peled says. Some patients who have been on this combination as a part of LEAP-006 for more than 2 years have achieved good results, Peled explains. Lenvatinib plus pembrolizumab and chemotherapy could increase response rate and make responses more durable, Peled adds.

Since lenvatinib is carries known for patients at its maximum dose, a dose adjustment was made for LEAP-006, leading to optimal results with a well-tolerated regimen, Peled continues. By using a more tolerable dose of lenvatinib, the idea is to manipulate the microenvironment to allow for more reactions in the immune system with the full combination, Peled concludes.

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Nir Peled, MD, PhD, FCCP, discusses the rationale of evaluating the combination of lenvatinib and pembrolizumab plus chemotherapy in non–small cell lung cancer.


Dr. Peled on the Rationale of Evaluating Lenvatinib/Pembrolizumab with Chemotherapy in NSCLC

Nir Peled, MD PhD, senior medical oncologist at the Thoracic Cancer Unit at Davidoff Cancer Center and the head of the research and detection unit for thoracic malignancies at the Sheba Medical Center, Tel Hashomer, Israel, discusses next-generation sequencing in lung cancer.

If an oncologist has a clinical suspicion that a patient has a mutation-driven lung cancer, testing should not stop until every possible mutation has been ruled out, says Peled. Next-generation sequencing can be used to identify patients that may respond to targeted therapies.

In a cohort of 100 patients with lung cancer there was a 66% response rate to targeted therapies in those who were positive for targetable mutations by next-generation sequencing. Half of these patients would have otherwise been on chemotherapy if only traditional tests had been used, says Peled. This is a game-changer, he says.

However, there are cost and educational barriers to the full implementation of next-generation sequencing that need to be overcome, says Peled.

Nir Peled, MD PhD

Articles

Dr. Peled on the Rationale of Evaluating Lenvatinib/Pembrolizumab with Chemotherapy in NSCLC

Dr. Nir Peled on Next-Generation Sequencing in Lung Cancer