Nivolumab has demonstrated promising activity for patients with refractory non-small cell lung cancer (NSCLC), notes H. Jack West, MD. In a phase II trial that compared the PD-1 inhibitor nivolumab with docetaxel, the overall response rate (ORR) with nivolumab was 15%, the estimated 1-year survival rate was 41%, and the median survival was 8.2 months.

The biggest challenge facing the phase II study of nivolumab versus docetaxel was crowd control, West notes. Anecdotally, West notes that 1 patient in the study with rapidly progressing disease responded exceptionally well, with a response seen within the first week of receiving treatment. This patient went from requiring aggressive pain management and palliative care to having no pain at all, West notes.

The efficacy seen in this experience characterizes the excitement surrounding the immune checkpoint inhibitors. However, the response seen for this patient is not the status quo, West states. The challenge currently facing treatment with PD-1 inhibitors is the discovery of an effective biomarker to predict response, West notes. Clinical trials have assessed the utility of PD-L1 expressions as a biomarker of response. However, patients with low expression of the ligand still experience responses, and should not be excluded from treatment. This warrants the continued exploration of other biomarkers, West believes.

In the next few years, West remains optimistic that PD-1 inhibitors will be integrated into the treatment paradigm for patients with advanced NSCLC. The next goal of research will be to apply these therapies to the curative setting as adjuvant therapy or as consolidations therapies following chemotherapy or radiation, West believes. In this setting, these agents could potentially increase cure rates.