Dr. Kelly on Challenges With Starting Immunotherapy in Lung Cancer

Karen Kelly, MD, associate director for clinical research, University of California (UC) Davis Comprehensive Cancer Center, and professor of medicine, UC Davis Health, discusses challenges with choosing when to start immunotherapy in patients with lung cancer.

When to start immunotherapy in lung cancer is an important topic of discussion in the real-world setting, says Kelly. Data from 8 trials examining immunotherapy/chemotherapy combinations and 3 trials evaluating immunotherapy alone support the use of immunotherapy as the first line of treatment for patients with advanced disease who do not have an oncogenic driver. However, some real-world situations do not necessarily allow for the use of up-front immunotherapy, says Kelly.

For example, 1 patient that Kelly treated was supposed to begin chemoimmunotherapy but fell, broke his hip, and required surgery. Because he was symptomatic, Kelly decided to treat him with chemotherapy alone in the hospital. For another patient who was younger, very symptomatic with a lot of disease burden, who may have had an actionable mutation, but could not wait for results to return, Kelly decided to begin chemotherapy alone.

Scenarios like these create a dilemma regarding when immunotherapy should be added to treatment, says Kelly. Should immunotherapy be used in combination with the second cycle of chemotherapy? Both of Kelly’s patients responded to their first cycle of chemotherapy in terms of symptom improvement; therefore, could immunotherapy wait until the second-line setting? These are important questions to address in this space, concludes Kelly.