Dr. Liu on Potentially Promising Combinations in ALK-Positive NSCLC

Stephen Liu, MD, associate professor of medicine, Division of Hematology and Oncology, Georgetown University Medical Center, discusses potentially promising combinations in ALK-positive non—small cell lung cancer (NSCLC).

At the 2018 Annual ASCO Meeting, there were combination studies of avelumab (Bavencio) with crizotinib, avelumab with lorlatinib, and atezolizumab (Tecentriq) and alectinib.

These were single-arm studies that were mostly looking at safety, says Liu. They showed impressive efficacy, although [they are already efficacious] on their own. The study of avelumab and crizotinib was notable because it showed a dose-limiting toxicity rate of 40%. It was not a safe combination, says Liu. Avelumab and lorlatinib looked more tolerable, but there are still significant toxicities with this combination.

The same applies to atezolizumab and alectinib. There is certainly rationale for that, Liu says. When alectinib was given, there was an increase in the infiltration of CD8-positive T cells in the tumor. This combination may be more than just additive, states Liu, though these agents are investigational. The safety of these combinations has to be confirmed before they are used in practice, concludes Liu.