ESMO 2019: Dr. Spigel Highlights Progress in Lung Cancer

David R. Spigel, MD, chief scientific officer, Sarah Cannon Research Institute, discusses updates in lung cancer presented at the 2019 ESMO Congress.

Interim survival data of the phase III IMpower110 study showed that atezolizumab (Tecentriq) monotherapy improved overall survival (OS) compared with platinum-based chemotherapy as a first-line treatment of patients with wild-type non—small cell lung cancer (NSCLC) with ≥50% expression of PD-L1 on tumor cells or ≥10% expression on tumor-infiltrating immune cells. At a median follow-up of 15.7 months, median OS was 20.2 months (95% CI, 16.5-not evaluable) in the atezolizumab arm versus 13.1 months (95% CI, 7.4-16.5) in the platinum-based chemotherapy arm (HR, 0.59; 95% CI, 0.40-0.89; P = .0106). These data indicate this could be a new standard of care for patients in this population, according to Spigel.

The CheckMate-227 trial showed that a first-line combination of nivolumab (Opdivo) and ipilimumab (Yervoy) led to a clinically meaningful improvement in OS compared with platinum-doublet chemotherapy in patients with advanced NSCLC, regardless of PD-L1 expression status. The median OS was 17.1 months with the nivolumab/ipilimumab combination versus 13.9 months with chemotherapy in patients regardless of PD-L1 status (HR, 0.73; 95% CI, 0.64-0.84). In a cohort of patients with PD-L1 expression ≥1%, the median OS for nivolumab/ipilimumab versus chemotherapy was 17.1 months and 14.9 months, respectively (HR, 0.79; 97.72% CI, 0.65-0.96; P = .007). Based on these data, Spigel believes nivolumab/ipilimumab will become a frontline therapy available to patients with advanced NSCLC.

In small cell lung cancer (SCLC), follow-up of nearly 2 years from the IMpower133 trial showed that the addition of atezolizumab to first-line carboplatin plus etoposide (CP/ET) led to improved OS compared with placebo plus CP/ET. At a median follow-up of 22.9 months, median OS remained 12.3 months in patients on the atezolizumab arm versus 10.3 months in patients on the placebo arm (HR, 0.76; 95% CI, 0.60-0.95; P = .0154). This is a big step forward for patients with SCLC, according to Spigel, but further research needs to be done to learn more about the therapy and who is eligible to receive it.

Genomic testing has expanded to include various biomarkers that can be detected in the blood, including tumor mutational burden (TMB) and EFGR; these biomarkers can help guide therapy, says Spigel. Sarah Cannon Research Institute, Spigel's institution, performs about 700 molecular tests per month and about half of them are blood tests. These blood tests will dominate the future of molecular testing, says Spigel, who adds that he is looking forward to seeing further clinical trials in this space.