Sandip P. Patel, MD, medical oncologist, assistant professor of medicine, University of California, San Diego, discusses the impact of immunotherapy on the treatment of patients with non—small cell lung cancer (NSCLC).

Immunotherapy has revolutionized the treatment of many cancers, including NSCLC. Historically, the only option for this population was chemotherapy, says Patel. There are now a wealth of options in various settings of the disease, including anti—PD-1 therapy.

In stage III NSCLC, durvalumab (Imfinzi) was approved by the FDA based on findings from the PACIFIC study. In the phase III PACIFIC study, the PD-L1 inhibitor improved median progression-free survival (PFS) by 11.2 months compared with placebo. The 12-month PFS rate was 55.9% versus 35.3%, and the 18-month PFS rate was 44.2% versus 27.0%, favoring the durvalumab arm. As a result of these findings, patients in this setting can receive 1 year of durvalumab consolidation therapy after chemoradiation.

In the metastatic setting, findings from the KEYNOTE-189 study showed that combining pembrolizumab (Keytruda) with standard chemotherapy in the frontline setting reduced the risk of death by over 50% in patients with nonsquamous NSCLC without 

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Sandip P. Patel, MD, medical oncologist, assistant professor of medicine, University of California, San Diego, discusses the impact of immunotherapy on the treatment of patients with non–small cell lung cancer.

Dr. Patel Discusses Impact of Immunotherapy on NSCLC

Sandip P. Patel, MD, medical oncologist, assistant professor of medicine, University of California, San Diego, discusses novel agents for the treatment of patients with non—small cell lung cancer (NSCLC).

The majority of agents that are being investigated in the post—PD-1 setting will lead to novel immunologic approaches, says Patel. These are drugs that target the IDO pathway. Although, there have been questions in light of the recent negative melanoma data with epacadostat and pembrolizumab (Keytruda). There are a variety of other novel agents such as NKTR-214 which is an IL-2 immuno-conjugate, CSF1R, and OX40. These immunologically targeted agents show preliminary signals of efficacy, states Patel. It remains to be seen if these agents induce durable responses.

Resistance comes in 2 forms in the post—PD-1 setting. There are patients who have primary resistance to PD-1–directed strategies as a result of "cold" tumor environments. These patients may benefit from vaccination strategies such as tumor infiltrating lymphocyte therapies, this and other novel approaches can make "cold" tumors "hot." Patients who have adaptive resistance may benefit from strategies that upregulate interferon gamma and increase antigen presentation. It’s very likely that in the post–PD-1 setting, there are at least 2 different pathways of resistance mechanisms that will require novel agents, concludes Patel.

Sandip P. Patel, MD, medical oncologist, assistant professor of medicine, University of California, San Diego, discusses novel agents for the treatment of patients with non–small cell lung cancer (NSCLC).

Sandip P. Patel, MD

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Dr. Patel Discusses Impact of Immunotherapy on NSCLC

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