Dr. Dietrich on Navigating the NSCLC Treatment Landscape

Martin Dietrich, MD, PhD, medical oncologist, Florida Cancer Specialists & Research Institute, assistant professor, University of Central Florida, shares how he navigates the non–small cell lung cancer (NSCLC) treatment landscape.

Because the regimens examined in the phase 3 KEYNOTE-189 (NCT02578680) and KEYNOTE-407 (NCT02775435) trials are so broadly applicable, they have shifted focus away from utilizing biomarkers to guide treatment for patients with NSCLC, according to Dietrich. The long-term effect of these regimens remains highly dependent on PD-L1 expression levels, and an incremental benefit is observed the higher the PD-L1 expression is, Dietrich says. In the PD-L1–negative population, single-agent PD-1 inhibitors do not have a lasting effect. As such, for these patients, combination strategies must be explored, Dietrich adds. 

In terms of patients with PD-L1–high disease, the combination of ipilimumab (Yervoy) plus nivolumab (Opdivo) has received regulatory approval, and has been shown to provide an absolute survival benefit of 10% at 4 years compared with nivolumab alone, Dietrich adds. Looking forward, TIGIT antibodies will be integral in enhancing PD-L1–positive expression, Dietrich concludes.