Dr. Neal on Immunotherapy Combinations in Lung Cancer

Joel Neal, MD, PhD, assistant professor of Medicine (Oncology), Stanford University Medical Center, discusses what immunotherapy combinations oncologists are currently using in the treatment of patients with lung cancer.

Immunotherapy can be combined with nearly any other agent, says Neal, including chemotherapy, radiation, and most importantly, other immunotherapies. The real goal is to learn how to tailor these therapies for more patients and to yield longer and more durable responses. While patient selection is improving, researchers still need to actively explore who is not appropriate to receive these therapies. Additional questions revolve around who should receive immunotherapy in first-line, as well as in second- and third-line settings.

There are a number of clinical trials in this realm. Researchers are exploring combinations with both radiation and with chemotherapy. However, Neal is not necessarily convinced that combinations with immunotherapy and chemotherapy are actually synergistic.

One novel combination being explored is ipilimumab (Yervoy) plus nivolumab (Opdivo). Preliminary evidence of the CheckMate-012 trial suggests that the combination of nivolumab plus ipilimumab achieves higher response rates in advanced non-small cell lung cancer (NSCLC) than nivolumab alone, with good tolerability.

A phase III study, CheckMate-227, is assessing nivolumab alone, nivolumab plus ipilimumab, nivolumab plus platinum-doublet chemotherapy, and platinum-doublet chemotherapy alone in patients with stage IV NSCLC. The goal of this trial is to see if any of these regimens significantly improves progression-free survival and/or overall survival.