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PER® International Congress on Immunotherapies in Cancer: Focus on Practice-Changing Application

The emergence of checkpoint inhibitors has transformed the second-line treatment of patients with metastatic bladder cancer (mBC). However, questions regarding the utility of immunotherapy in the frontline setting remain unanswered, leaving chemotherapy as the standard-of-care option, said Arjun V. Balar, MD.

Although atezolizumab (Tecentriq) and pembrolizumab (Keytruda) have frontline FDA indications for patients with PD-L1–positive, cisplatin-ineligible mBC, ongoing trials are evaluating immunotherapy combinations as well as emerging modalities such as antibody-drug conjugates (ADCs).

Additionally, immunotherapy is being brought into muscle-invasive bladder cancer (MIBC) and non–MIBC, and the modality may have utility in combination with chemoradiation in MIBC.

 International Congress on Immunotherapies in Cancer

, a program run by Physicians’ Education Resource

, Balar discussed key nuances to consider when utilizing immunotherapy in mBC, as well as emerging strategies in muscle-invasive and non–muscle-invasive disease. He is an associate professor within the Department of Medicine at NYU Grossman School of Medicine and director of the Genitourinary Medical Oncology Program and medical director of the Clinical Trials Office at NYU Langone Health’s Perlmutter Cancer Center.

Chemotherapy Gives Way to Checkpoint Inhibition in Second-Line mBC

Five PD-1/PD-L1 inhibitors have been FDA approved for the second-line treatment of patients with mBC, showing improved responses compared with single-agent chemotherapy.

In the frontline setting, cisplatin has demonstrated improved survival rates with some curative benefit. However, up to two-thirds of patients with mBC are cisplatin ineligible because of comorbidities; they cannot derive benefit from cisplatin and generally have poor outcomes.

In April and May 2017, respectively, the FDA approved atezolizumab and pembrolizumab for the first-line treatment of previously untreated patients with cisplatin-ineligible disease based on findings from cohort 1 of the phase 2 IMvigor210 (NCT02108652) and phase 2 KEYNOTE-052 (NCT02335424) trials, respectively. The objective response rate was 24% with atezolizumab and 28.6% with pembrolizumab.

However, in May 2018, the FDA issued a safety alert of decreased survival with single-agent atezolizumab or pembrolizumab among patients with mBC who have not received prior therapy and who have low PD-L1 expression; the alert was based on findings from the ongoing phase 3 IMvigor130 (NCT02807636) and KEYNOTE-361 (NCT02853305) trials.

 As such, updates to the agents’ labels require the use of an FDA-approved companion diagnostic to determine PD-L1 expression for patients with advanced cisplatin-ineligible bladder cancer.

“Systematically, we had to roll back some of the excitement [generated with first-line checkpoint inhibitors] when the label was restricted to those who are PD-L1 positive or chemotherapy ineligible. Now, there is some controversy about [checkpoint inhibitors’] continued use at all in the first-line setting,” said Balar.

Chemotherapy Combos Yield Underwhelming Data in the Metastatic Setting

In the IMvigor130 trial, the progression-free survival (PFS) in the intention-to-treat population was 8.2 months (95% CI, 6.5-8.3) with atezolizumab plus chemotherapy versus 6.3 months (95% CI, 6.2-7.0) with placebo plus chemotherapy (stratified HR, 0.82; 95% CI, 0.70-0.96; 1-sided 

 = .007), meeting the coprimary end point of the study.

“Anytime we look at a curve like this, we think: Yes, it is statistically significant, but is it clinically meaningful?” said Balar. “The curves separate, and they maintain separation, but in terms of what we were hoping to see, it certainly didn’t mirror what we saw in advanced lung cancer.”

However, subgroup analyses of overall survival (OS) showed that patients with PD-L1–negative disease have an increased risk of death within the first year of single-agent atezolizumab compared with chemotherapy, which led to the FDA label change.

The KEYNOTE-361 trial (NCT02853305) yielded similar findings, and the PFS results did not meet statistical significance.

Results of the pivotal phase 3 JAVELIN Bladder 100 trial (NCT02603432) have called the use of immunotherapy into question, although it was a maintenance therapy–powered trial. The results demonstrated a 31% reduction in the risk of death with avelumab (Bavencio) maintenance versus best supportive care (BSC) in the overall population of patients with unresectable locally advanced or mBC who derived a complete response (CR) or partial response or stable disease with standard first-line chemotherapy (95% CI, 0.56-0.86; 

 In the PD-L1–positive population, the risk of death was reduced by 44% (95% CI, 0.40- 0.79; 

Notably, 6.3% of patients who received avelumab plus BSC and 43.7% of patients who received BSC alone discontinued maintenance therapy and received a PD-1/PD-L1 inhibitor as subsequent therapy.

FDA approved avelumab for the frontline maintenance treatment

 of patients with locally advanced or mBC that has not progressed with first-line platinum-containing chemotherapy.

“Along with some of the data from [KEYNOTE-361], this is saying that maybe we should give everyone platinum-based chemotherapy up front and really reserve immunotherapy for the second-line setting,” said Balar.

Other ongoing trials are continuing to parse out the role of immunotherapy, particularly by evaluating CTLA-4 inhibitors in the metastatic setting. However, the phase 3 DANUBE trial (NCT02516241), which evaluated durvalumab (Imfinzi) alone versus in combination with tremelimumab versus chemotherapy, did not meet either coprimary end point.

“High-volume, symptomatic disease [should] be treated with chemotherapy, irrespective of PD-L1 status,” stated Balar. “Small-volume, asymptomatic disease can be treated effectively with immunotherapy, also irrespective of PD-L1 status. PD-L1 expression is a dubious value in metastatic disease. Perhaps [PD-L1 status is useful] in equivocal cases where we are not sure what direction to go in. For chemotherapy-ineligible patients, immunotherapy remains the only viable option.”

Antibody-drug conjugates, such as enfortumab vedotin-ejfv (Padcev) and sacituzumab govitecan-hziy (Trodelvy), could reshape the third-line treatment of patients with mBC, said Balar. 

In December 2019, enfortumab vedotin received an accelerated approval from the FDA for the treatment of patients with locally advanced or mBC after prior PD-1/ PD-L1 therapy and platinum-containing chemotherapy. Long-term follow-up of the EV-201 trial (NCT03219333), findings of which served as the basis for the approval, demonstrated a 50.4% OS rate at 12 months and a 34.2% OS rate at 18 months with enfortumab vedotin in this patient population.

Additionally, combinations with ADCs and checkpoint inhibitors, such as enfortumab vedotin and pembrolizumab in the ongoing phase 2 EV-103 trial (NCT03288545), are under investigation to potentially introduce chemotherapy-free options for patients with advanced disease. 

Traditionally, patients with MIBC are treated with radical cystectomy; however, a significant portion of patients relapse after surgery. Notably, singleagent immunotherapy has demonstrated pathologic CR rates in the range of 30% to 40% in the neoadjuvant setting. Additionally, checkpoint inhibitors have shown some responses in the adjuvant setting, explained Balar.

The trimodality of chemoradiation plus immunotherapy is being evaluated for this patient population in the ongoing KEYNOTE-992 (NCT04241185) and SWOG 1806 (NCT03775265) trials and could offer a potential option for patients who want to avoid radical cystectomy.

Finally, initial findings from the ongoing KEYNOTE-057 trial (NCT03711032) demonstrated encouraging early efficacy and CR rates with seemingly durable responses with pembrolizumab monotherapy in patients with high-risk non-MIBC who are unresponsive to BCG and who decline to undergo or are ineligible for cystectomy, according Balar, lead author of the study. 

“The benefit of immunotherapy is still evolving, especially in the case of bladder preservation in non-MIBC and also, in particular, when we combine it with trimodality bladder preservation,” concluded Balar.

Balar AV, Dreicer R, Loriot Y, et al. Atezolizumab (atezo) in first-line cisplatin-ineligible or platinum-treated locally advanced or metastatic urothelial cancer (mUC): long-term efficacy from phase 2 study IMvigor210. 

2018;36(suppl 15):4523-4523. doi:10.1200/JCO.2018.36.15_suppl.4523

Vuky J, Balar AV, Castellano D, et al. Long-term outcomes in KEYNOTE-052: phase II study investigating first-line pembrolizumab in cisplatin-ineligible patients with locally advanced or metastatic urothelial cancer. 

2020;38(23):2658-2666. doi:10.1200/JCO.19.01213

Galsky MD, Arija JAA, Bamias A, et al. Atezolizumab with or without chemotherapy in metastatic urothelial cancer (IMvigor130): a multicentre, randomised, placebo-controlled phase 3 trial. 

. 2020;395(10236):1547-1557. doi:10.1016/S0140-6736(20)30230-0

Bellmunt J, de Wit R, Vaughn DJ, et al. Pembrolizumab as second-line therapy for advanced urothelial carcinoma. 

. 2017;376(11):1015-1026. doi:10.1056/NEJMoa1613683

Powles T, Park SH, Voog E, et al. Avelumab maintenance therapy for advanced or metastatic urothelial carcinoma. 

2020;383(13):1218-1230. doi:10.1056/NEJMoa2002788

FDA approves Bavencio as first-line maintenance treatment for patients with locally advanced or metastatic urothelial carcinoma. News release. Pfizer. June 30, 2020. Accessed December 14, 2020. bit.ly/2YO7gVk.

Powles T, van der Heijden MS, Castellano D, et al. Durvalumab alone and durvalumab plus tremelimumab versus chemotherapy in previously untreated patients with unresectable, locally advanced or metastatic urothelial carcinoma (DANUBE): a randomised, open-label, multicentre, phase 3 trial. 

2020;21(12):1574-1588. doi:10.1016/S1470-2045(20)30541-6

O’Donnell P, Galsky M, Rosenberg JE, et al. EV-201: long-term results of enfortumab vedotin monotherapy for locally advanced or metastatic urothelial cancer previously treated with platinum and PD-1/PD-L1 inhibitors. 

. 2020;31(suppl 4):579-580. doi:10.1016/j.annonc.2020.08.818  

The emergence of checkpoint inhibitors has transformed the second-line treatment of patients with metastatic bladder cancer. However, questions regarding the utility of immunotherapy in the frontline setting remain unanswered, leaving chemotherapy as the standard-of-care option.

Immunotherapy Finds a Foothold in Metastatic Bladder Cancer, But Frontline Challenges Remain

Joshua Brody, MD, director of the Lymphoma program at Icahn School of Medicine, Mount Sinai Hospital, discusses the role of immunotherapy in Hodgkin lymphoma.

Notably, patients with Hodgkin lymphoma are more responsive to immunotherapy than patients with other tumor types, says Brody. Randomized phase 3 data have led to the approvals of multiple anti–PD-1 agents in Hodgkin lymphoma based on superior efficacy findings compared with other standards, such as antibody-drug conjugates, Brody says.

Moreover, the response rates for PD-1 inhibitors in patients with chemotherapy-refractory Hodgkin lymphoma are around 70%, with most patients achieving complete responses or durable remissions. Five years ago, many patients had to adjust their daily schedule to undergo chemotherapy, with limited curative potential. Moreover, many of these patients would go on to receive a stem cell transplant and develop progressive disease after. The introduction of PD-1 inhibitors has largely improved the burden of therapy for these patients.

Ultimately, with this new therapy, patients can achieve more durable responses, even in the refractory setting. As such, the field is looking to expand the utility of immunotherapy into earlier lines of therapy or into the maintenance setting, Brody concludes.

Joshua Brody, MD, discusses the role of immunotherapy in Hodgkin lymphoma. 


Dr. Brody on the Role of Immunotherapy in Hodgkin Lymphoma 

Jeffrey S. Weber, MD, PhD, ​deputy director and co-director of the melanoma program, Laura and Isaac Perlmutter Professor of Oncology, Department of Medicine, NYU Langone Health’s Perlmutter Cancer Center, 2016 Giant of Cancer Care® in Melanoma, discusses the toxicities associated with immunotherapy in lung cancer.

Safety data have shown that PD-1 and PD-L1 inhibitors can cause similar adverse effects (AEs) for patients with lung cancer. As such, it is easy to discuss potential AEs with patients receiving single-agent pembrolizumab (Keytruda), durvalumab (Imfinzi), or avelumab (Bavencio), or the combination of nivolumab (Opdivo) and ipilimumab (Yervoy). Though, it’s critical to make patients aware of the more significant toxicities that could arise, Weber says.

Notably, significant toxicities are defined as those that have a serious impact on a patient’s life, require additional therapies, or lead to hospitalization, says Weber. Serious toxicities occur in about 10% of patients receiving single-agent PD-1 however, significant AEs could affect about 40% to 50% of patients being treated with immunotherapy combinations, Weber concludes.

Jeffrey S. Weber, MD, PhD, discusses the toxicities associated with immunotherapy in lung cancer.

Dr. Weber on the Toxicities Associated With Immunotherapy in Lung Cancer 

Checkpoint inhibitors have failed to improve progression-free survival (PFS) and overall survival (OS) as second-line therapy and maintenance therapy in small cell lung cancer (SCLC), but this class of agents continue to show encouraging activity worthy of a paradigm shift up front.

The frontline role with immunotherapy has extended to patients with mesothelioma, as well. 

“SCLC and mesothelioma have been difficult cancers to treat, and immunotherapy has not made an impact until very recently, where, in the first-line setting, we have improved outcomes and new standards of care for the treatment of SCLC and mesothelioma,” said Naiyer A. Rizvi, MD, Price Family ​Professor of ​Medicine, director of Thoracic Oncology, and co-director of Cancer Immunotherapy at Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, said in a presentation during the 

 International Congress on Immunotherapies in Cancer

The first robust trial that demonstrated the potential for immunotherapy up front was the phase 3 IMpower133 trial. In the trial, patients with extensive-stage SCLC were randomized 1:1 to 1200 mg of intravenous atezolizumab (Tecentriq) plus carboplatin or etoposide for four 21-day cycles, or placebo plus carboplatin or etoposide followed by maintenance atezolizumab and placebo, respectively.

At a median follow-up of 13.9 months, the median PFS was 5.2 months in the atezolizumab arm vs 4.3 months in the placebo arm (HR, 0.77; 95% CI, 0.62-0.96; 

 The 6-month PFS rate was 30.9% in the atezolizumab arm vs 22.4% in the placebo arm. The 12-month PFS rates were 12.6% and 5.4%, respectively. 

At a median follow-up of 22.9 months, the median OS was 12.3 months with atezolizumab vs 10.3 months with placebo (HR, 0.76; 95% CI, 0.60-0.95; 

 The 18-month OS rates were 34.0% and 21.0%, respectively. The 24-month OS rates were 22.0% and 16.8%, respectively. 

The median duration of response (DOR) was 4.2 months in the atezolizumab arm vs 3.9 months in the placebo arm (HR, 0.70; 95% CI, 0.53-0.92). However, more than half of patients in the placebo arm experienced ongoing response in the atezolizumab arm at last follow-up (n = 7 vs n = 18, respectively).

In the subgroup analysis, all patients except those with brain metastases (HR, 1.07; 95% CI, 0.47-2.43) derived benefit from atezolizumab.

“IMpower133 is really the first study in over 20 years to really show a meaningful improvement in OS vs standard of care in first-line SCLC. These data led to the adoption of chemotherapy plus immunotherapy as a first-line standard of care for extensive-stage SCLC,” said Rizvi.

These data were recapitulated in findings from the phase 3 CASPIAN trial, said Rizvi. In the trial, patients with extensive-stage SCLC were randomized 1:1:1 to 1500 mg of durvalumab (Imfinzi) plus etoposide every 3 weeks for up to 4 cycles, etoposide every 3 weeks for up to 6 cycles, or durvalumab plus 75 mg of tremelimumab plus etoposide for up to 4 cycles, followed by durvalumab, optional prophylactic irradiation, and durvalumab, respectively. 

At over 2 years of follow-up, the median OS was 12.9 months in the durvalumab/etoposide arm vs 10.5 months in the etoposide arm (HR, 0.75; 95% CI, 0.62-0.91; 

 = .0032). The 24-month OS rates were 22.2% and 14.4% respectively.

The median PFS was 5.1 months in the durvalumab/etoposide arm vs 5.4 months in the etoposide arm (HR, 0.80; 95% CI, 0.66-0.96). The 24-month PFS rates were 11.0% and 2.9%, respectively.

“The trial was not powered to compare durvalumab plus chemotherapy vs durvalumab plus tremelimumab plus chemotherapy, but these 2 arms did perform fairly similarly, and both did perform similarly to chemotherapy alone,” said Rizvi.

In an exploratory analysis, tumor mutational burden was not shown to be predictive of an improvement in OS for durvalumab plus or minus tremelimumab/etoposide vs etoposide alone, indicating that the marker should not be used to select patients for treatment.

Despite the progress that has been made, there is room for improvement, said Rizvi, who cited the phase 3 SKYSCRAPER-02 trials as 1 study that could push the needle further.

In SKYSCRAPER-02, patients will be randomized to 1:1 to 1200 mg of atezolizumab plus chemotherapy plus 600 mg of tiragolumab every 3 weeks for 4 cycles or atezolizumab plus placebo in the same schedule, followed by atezolizumab/tiragolumab or atezolizumab/placebo, respectively. 

Immunotherapy has also been subject to research in mesothelioma, explained Rizvi, who pointed to the phase 3 CheckMate 743 trial, where patients with malignant pleural mesothelioma will be randomized 1:1 to 3 mg/kg of nivolumab (Opdivo) every 2 weeks plus 1 mg/kg of ipilimumab (Yervoy) every 6 weeks or cisplatin or carboplatin plus pemetrexed for 6 cycles.

Initial results from CheckMate 743 demonstrated a median PFS of 6.8 months with chemotherapy vs 7.2 months with chemotherapy (HR, 1.00; 95% CI, 0.82-1.21). The 24-month PFS rates were 16% and 7%, respectively.

OS data, when broken down by subtype, revealed a significant improvement with the combination vs chemotherapy in patients with non-epithelioid tumors, at 18.1 months vs 8.8 months, respectively (HR, 0.46; 95% CI, 0.31-0.68). The 24-month OS rates were 38% and 8%, respectively. 

In epithelioid tumors, the median OS was 18.7 months with the combination vs 16.5 months with chemotherapy (HR, 0.86; 95% CI, 0.69-1.08). The 24-month OS rates were 42% and 33%, respectively.  

“These data are really meaningful, supporting immunotherapy only as first-line therapy [in mesothelioma],” said Rizvi.

Additionally, although OS favored the combination vs chemotherapy, irrespective of PD-L1 expression, patients who had greater than 1% expression derived more benefit from the combination (HR, 0.69) vs those with PD-L1 expression less than 1% (HR, 0.94).

The response rates were comparable in the combination and chemotherapy-alone arm, at 40% and 43%, respectively. The median DOR was 11.0 months and 6.7 months, respectively. At 2 years, 32% of patients in the combination arm were still in response vs 8% in the chemotherapy-alone arm. 

Horn L, Mansfield AS, Szczęsna A, et al. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. 

. 2018;379(23):2220-2229. doi:10.1056/NEJMoa1809064.

Liu SV, Horn L, Mok T, et al. IMpower133: Characterisation of long-term survivors treated first-line with chemotherapy ± atezolizumab in extensive-stage small cell lung cancer. 

. 2020;31(suppl 4):S974-S987. doi:10.1016/annonc/annonc290 

Paz-Ares LG, Dvorkin M, Chen Y, et al. Durvalumab ± tremelimumab + platinum-etoposide in first-line extensive-stage SCLC: updated results from the phase III CASPIAN study. 

. 2020;38(suppl 15):9002. doi:10.1200/JCO.2020.38.15_suppl.9002

Goldman JW Garassino MC, Franks A, et al. Durvalumab ± tremelimumab + platinum-etoposide in 1L ES-SCLC: characterization of long-term clinical benefit and tumor mutational burden in CASPIAN. 

. 2020;31(suppl 4):S1212-S1213. doi:10.1016/j.annonc.2020.08.2328

Bass P, et al. First-line nivolumab + ipilimumab vs chemotherapy in unresectable malignant pleural mesothelioma: CheckMate 743. Presented at: 16th World Conference on Lung Cancer; September 6-9; Denver, CO. Abstract 3. 

Checkpoint inhibitors have failed to improve progression-free survival and overall survival as second-line therapy and maintenance therapy in small cell lung cancer, but this class of agents continue to show encouraging activity worthy of a paradigm shift up front. 

Immunotherapy Finds a Role in Frontline Small Cell Lung Cancer and Mesothelioma

Although value and benefit are derived from immunotherapy in many areas of oncology, immunotherapeutic agents do carry a number of toxicities, according to Mario Sznol, MD, who added that these related events can be swiftly managed with strong communication, awareness, and knowledge.

“One of the biggest challenges with the administration of immunotherapy is the management of the toxicities that arise, such as gastrointestinal toxicities, colitis, enteritis, hepatitis, liver function, and endocrine disorders, along with others,” explained Sznol, a professor of medicine and codirector of Yale SPORE in Skin Cancer at Yale Cancer Center. “Some of the other toxicities include myocarditis, myositis, and myasthenia gravis—all 3 could arise in the same patient. Ultimately, we must stay informed on these toxicities, along with the best ways to manage them, to ensure that our patients derive the most benefit possible from immunotherapy.”

, Sznol, who was also cochair of the 5th Annual International Congress on Immunotherapies in Cancer®, a program run by Physicians’ Education Resource®, discussed the critical importance of being aware of the immune-related toxicities that could arise when treating patients, along with the best ways to manage them.

How do immune-related toxicities vary among the different checkpoint inhibitors?

The most common agents used in the community are anti–PD-1 and anti–CTLA-4 agents. The immune-related adverse effects [irAEs] seen with both of these classes of agents are very similar. With anti–PD-1 agents, we see more pneumonitis but fewer cases of diabetes mellitus, for example. However, the general spectrum of toxicities is similar and can affect almost every organ.

Things start to become more complicated when we combine therapies. For example, when you combine an anti–PD-1 agent with an antiCTLA-4 agent, there are more toxicities. In such cases, we need to determine which toxicities came from the immunotherapy and which ones came from the chemotherapy. In addition, there are now new combinations involving VEGF inhibitors and anti–PD-1. If a patient experiences diarrhea, we must determine which therapy caused it. Notably, very few patients receive IL-2 at this time; however, that agent could result in cytokine-related toxicities.

How do you manage these irAEs in your own practice?

We have a lot of experience with their management because we’ve been dealing with them for more than 10 years. It’s important to have well-trained nurses and other health care providers, along with those who are there to quickly answer the phones. The clinical secretaries play a huge role because they know how to route and manage these calls. After all, they are the first line of defense and the ones who do the initial management, particularly supportive care. In general, we tend to keep a close eye on our patients because, for some of these toxicities, they can quickly go from mild to very severe cases. Ultimately, close communication is key.

What other advice can you give regarding the optimal management of irAEs?

We should not be afraid of these agents. Instead, we should be vigilant and informed on all the potential toxicities that may arise. In addition, we should be suspicious about any AE that a patient may experience because it could be an immunerelated toxicity. If we catch these toxicities early on, we can manage them early.

As long as we are monitoring our patients and administering these agents safely, I believe immunotherapy, especially in the skin cancer arena, is incredibly effective. These agents provide value to a large number of patients. As long as we know what toxicities to expect, we are all capable of effectively managing these toxicities.

In melanoma specifically, what are some of your go-to immunotherapy regimens?

For melanoma, we also use the combination of an anti–PD-1 and an anti–CTLA-4 agent in most patients, such as nivolumab [Opdivo] and ipilimumab [Yervoy], although some patients receive nivolumab or pembrolizumab [Keytruda] alone. Whether to use a single-agent or a combination therapy is a lengthy discussion in the space. However, for almost all patients, if we’re going to administer a standard of care, we will use either single-agent antiPD-1 or in combination. Notably, we tend to favor the combination for a variety of reasons, even though combination therapies are associated with more AEs.

Even if we use anti–PD-1 as monotherapy first, the combination of an anti–PD-1 and anti–CTLA-4 inhibitor in the second-line setting still has a very respectable response rate. In the first- and second-line settings, for almost all patients with metastatic melanoma, we will start off with immunotherapy.

In the adjuvant setting, it’s a little different. Although PD-1 inhibitors are approved in the adjuvant setting for melanoma, there is a decision of whether to use targeted therapy or immunotherapy for patients with BRAF mutations. Therefore, this becomes more complicated.

What immunotherapeutics are emerging in the pipeline with some practicechanging potential?

There are many emerging immunotherapy agents that we're excited about. We look forward to hearing more about tumor-infiltrating lymphocytes (TIL) adoptive cell therapy. Regarding melanoma, I don't believe that we're going to see any agents that are nearly as active as anti–PD-1 alone in at least 40% to 50% of patients.

Even so, I believe a number of agents out there will give us meaningful responses in small subsets, probably in combination with anti–PD-1. There could be something such as an anti-CD40 or an anti-LAG3. It could also be one of the many intratumoral therapies or adoptive cell therapy with TIL. The list goes on.

Recently, during the 2020 Society for Immunotherapy of Cancer Annual Meeting, interesting data were presented on the first-in-class, nextgeneration, DuoBody-PD-L1×4-1BB bispecific antibody, GEN1046, in solid tumors. Although I can’t list them all, we’re beginning to see the emergence of more active agents. The challenge is, once we shift over to the resistant/ refractory setting, each agent may be active only in a small subset of patients. We must determine which patients will derive the most benefit from each therapy.

What were some of the big takeaways from this year’s International Congress on Immunotherapies in Cancer®?

I was most excited about the TIL adoptive cell therapies. We invited Amod A. Sarnaik, MD, of Moffitt Cancer Center, who discussed this topic in much greater depth. However, all the presentations were great.

These meetings are critical in the field of oncology because experts are invited to present up-todate information in the areas that they specialize in. These data are then utilized in practice all over [oncology].

Mario Sznol, MD, discusses the critical importance of being aware of the immune-related toxicities that could arise when treating patients with cancer, along with the best ways to manage them. 

PER® International Congress on Immunotherapies in Cancer: Focus on Practice-Changing Application | Conference

Immunotherapy Finds a Foothold in Metastatic Bladder Cancer, But Frontline Challenges Remain

Dr. Brody on the Role of Immunotherapy in Hodgkin Lymphoma

Dr. Weber on the Toxicities Associated With Immunotherapy in Lung Cancer

Immunotherapy Finds a Role in Frontline Small Cell Lung Cancer and Mesothelioma

Sznol Advocates for More Awareness of Immune-Related Toxicities