Dr. Herbst on Immuno-Oncology Combinations in Lung Cancer

Roy S. Herbst, MD, PhD, chief of medical oncology, professor of medicine, Yale Cancer Center, Smilow Cancer Hospital, discusses combinations with immunotherapy in lung cancer.

Herbst believes combination immunotherapy will be superior to single-agent immunotherapy, except potentially in those who have PD-L1 expression <50%. Even then, the current response rate for pembrolizumab (Keytruda) in that patient population is 50%, which Herbst believes can be improved with combination immunotherapy. He adds that the combination that seems to work best so far is a immunotherapy/chemotherapy combination, based on data from the phase III KEYNOTE-189 trial. Across all PD-L1 expression levels, there was an improvement in survival for the chemotherapy/immunotherapy combination versus immunotherapy alone.

There are other combinations of immunotherapy/chemotherapy being explored, including combinations with inhibitors of CTLA-4, TIM-3, LAG-3, and CD73. There are various potential combinations, but nothing is ready for primetime as most of the studies are in the phase II setting. Herbst says physicians have to determine the factors and/or reasons for response, utilizing PD-L1 expression and tumor-infiltrating lymphocytes.

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