Ryan D. Gentzler, MD, assistant professor, Division of Hematology/Oncology, University of Virginia Health System, discusses combination therapies in non—small cell lung cancer (NSCLC).

Multiple combinations of immunotherapy and chemotherapy have been looked at, explains Gentzler. The KEYNOTE-189 trial looked at pembrolizumab (Keytruda) plus chemotherapy in patients with nonsquamous NSCLC and showed a survival benefit with the addition of pembrolizumab. The KEYNOTE-407 trial was a similar study that enrolled patients with squamous cell lung cancer that looked at platinum-doublet chemotherapy plus pembrolizumab. That study also showed a survival improvement. The combination of chemotherapy plus atezolizumab (Tecentriq) plus bevacizumab (Avastin) has also shown an improvement in overall survival compared with chemotherapy alone, notes Gentzler.

Physicians also have data from immunotherapy combinations. The CheckMate-227 trial compared ipilimumab (Yervoy) and nivolumab (Opdivo) with chemotherapy alone in a subset of patients who have a high tumor mutational burden. The trial showed an improvement in progression-free survival (PFS) with the combination. The CheckMate-227 trial had multiple arms, and one of the subsets that was looked at was the low PD-L1 expression group in which chemotherapy plus nivolumab was compared with chemotherapy alone. There was also an improvement in PFS within that comparison group, adds Gentzler.

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Ryan D. Gentzler, MD, assistant professor, Division of Hematology/Oncology, University of Virginia Health System, discusses combination therapies in non–small cell lung cancer (NSCLC).

Dr. Gentzler on Combination Therapies in NSCLC

Ryan D. Gentzler, MD, assistant professor, Division of Hematology/Oncology, University of Virginia Health System, discusses the role of chemotherapy in patients with metastatic non—small cell lung cancer (NSCLC).

Through the identification of different oncogenic drivers and development of targeted therapies, physicians have been able to delay the need for chemotherapy in patients with lung adenocarcinoma, explains Gentzler. Additionally, the use of immunotherapy has proven effective in smokers and patients who do not harbor oncogenic drivers.

Over the past year, data have shown that chemotherapy still has an important role in the treatment paradigm, says Gentzler. When physicians add chemotherapy to an immunotherapy regimen, it seems to show a better chance of response or a longer duration of response. Several studies have looked at chemotherapy as a backbone with immunotherapy. That combination has improved upfront responses, lengthened progression-free survival, and helped patients live longer. Now, trials are showing overall survival improvement by adding PD-1/PD-L1 inhibitors to standard chemotherapy, states Gentzler.

Ryan D. Gentzler, MD, assistant professor, Division of Hematology/Oncology, University of Virginia Health System, discusses the role of chemotherapy in patients with metastatic non–small cell lung cancer (NSCLC).

Ryan D. Gentzler, MD

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