Dr. Patil on Unmet Needs With the Use of Immunotherapy in NSCLC

Pradnya D. Patil, MD, FACP, Hematology and Medical Oncology fellow, Cleveland Clinic, discusses unmet needs that remain to be addressed with the use of immunotherapy in patients with non–small cell lung cancer (NSCLC).

Identifying biomarkers that can better predict benefit with the use of immunotherapy in NSCLC remains one of the biggest unmet needs in this space, Patil says. Currently, PD-L1 and tumor mutational burden (TMB) are the best biomarkers available for identifying patients who could benefit from immunotherapy. However, these markers are not perfect, Patil notes. For example, there are still instances of patients with very high PD-L1 expression who do not respond to immunotherapy, Patil says. Therefore, in addition to learning more about PD-L1’s and TMB’s roles as a predictive biomarker, identifying other biomarkers from the tumor microenvironment is necessary, Patil says. Tumor infiltrating lymphocytes could represent one novel biomarker, and researchers must better understand what these biomarkers mean, and how to incorporate that information into day-to-day treatment algorithms, Patil emphasizes.

Another area of unmet need remains stems from primary resistance or acquired resistance to immunotherapy. A significant amount of research has already been conducted to better understand mechanisms of resistance; however, it is important to understand how to design clinical trials that will allow clinicians to combat that resistance, Patil notes.

Toxicities associated with immunotherapy are also an area of need for patients with NSCLC, Patil emphasizes. For immunotherapy-based combinations with novel agents, it is necessary to obtain a better understanding of biomarkers to identify patients who are at risk for toxicities and learn how to better manage these toxicities, Patil explains. Although there are national and international guidelines for immune related adverse effects, there's still a bit of variability and not a lot of high level evidence in clinical practice, Patil concludes.