Dr Khalil on the Future Investigations of Immunotherapy in NSCLC

Maya Khalil, MD, assistant professor of medicine, Division of Hematology and Oncology, the University of Alabama at Birmingham (UAB), oncologist, O’Neal Comprehensive Cancer Center, UAB Medicine, discusses the future investigations of immunotherapy in non–small cell lung cancer (NSCLC).

Currently, when determining treatment for patients with metastatic NSCLC who do not harbor a targetable driver mutation, data from previously conducted trials could help inform that decision, Khalil says. For example, in the phase 3 CheckMate 9LA trial (NCT03215706) that evaluated nivolumab (Opdivo) and ipilimumab (Yervoy) plus chemotherapy vs chemotherapy alone in the frontline setting for patients with metastatic NSCLC, patients who had pretreated, stable, or asymptomatic brain metastases experienced progression-free survival and overall survival benefits with the combination vs chemotherapy alone. However, combination treatment with checkpoint inhibitors may not benefit patients with liver metastases, Khalil explains.

Evaluating data from different trials could help inform treatment decisions for individual patients, she says, adding that there is no longer a one-size-fits-all approach for treating patients with NSCLC. Factors that could help tailor treatment include burden of disease and sites of disease. For example, a patient with liver metastases and a large burden of disease may not be ideal candidates for immunotherapy alone, Khalil expands.

In the future, stratifying patients by PD-L1 expression and other molecular markers should be integrated into clinical trial designs, Khalil says. Investigating novel immunotherapy combinations, such as with anti–CTLA-4, anti–LAG-3, or other immune checkpoint inhibitors under development, could lead to a shift in the immunotherapy landscape in NSCLC, Khalil continues.

Immunotherapy has been proven to be an effective treatment option for many patients with NSCLC, displaying long-term disease control and durable responses, Khalil says. However, current immunotherapy options will not be effective for every patient, making it vital to find ways to identify those patients more or less likely to benefit from these therapies, Khalil concludes.