Introduction and Identifying Predictive Biomarkers

Recent Progress in the Treatment of SCLC

Personal Approach in Treatment Compared to Clinical Trials

Advice on Toxicity Management for SCLC Therapy

Use of I/O Regimen in Relapsed/Refractory SCLC

Data on FDA Approved Therapy for Relapsed/Refractory SCLC

Role of Newer Agents in the Treatment & Patient Selection

Unmet Needs and Challenges in Treating R/R SCLC

Q & A and Final Thoughts

Videos

Recent Advances in Small-Cell Lung Cancer

Anne Chiang, MD, PhD, an associate professor at the Yale School of Medicine, as well as the chief network officer and deputy chief medical officer with Smilow Cancer Network, discusses the rationale for combining immunotherapy with chemotherapy in lung cancer.

The rationale for using a combination of immunotherapy and chemotherapy in lung cancer is important to consider, says Chiang. The cytotoxic effects of the chemotherapy can be used to reduce tumor burden, but a whole host of effects can also make an environment more conducive to the effects of immunotherapy, explains Chiang. For example, the T-cell-to-tumor-cell ratio can be improved, T-cell inhibitory substances can be reduced, and tumor barriers can be altered, such as the pressure or the vasculature, to allow for better T-cell penetration.

The signaling may attract more T cells and their ultimate effects, which can enable tumor cells to be killed in a way that allows downstream signaling; this prompts dendritic cell activation, migration, and, ultimately, presentation of antigens in the lymph nodes and tumor microenvironments. That is the rationale behind why a combination of chemotherapy and immunotherapy would be particularly effective in patients with lung cancer. For example, in the CheckMate-9LA trial, patients with non–small cell lung cancer were treated with nivolumab (Opdivo) plus ipilimumab (Yervoy) in combination with chemotherapy. The rationale for adding 2 cycles of chemotherapy is to harness the immediate cytotoxic effect, as previous trials with immune checkpoint inhibitors show that it takes time for the therapy to work, concludes Chiang.

Anne Chiang, MD, PhD, discusses the rationale for combining immunotherapy with chemotherapy in lung cancer.

Dr. Chiang on the Rationale for Chemoimmunotherapy in Lung Cancer

Anne Chiang, MD, PhD, associate professor, Yale School of Medicine, chief network officer and deputy chief medical officer, Smilow Cancer Network, discusses unanswered questions with immunotherapy in non–small cell lung cancer (NSCLC). 

A number of single-agent and combination immunotherapy approaches are available in the NSCLC space, which can be a challenge, says Chiang. As such, there is a need to integrate better biomarkers into practice. This will lead to a better understanding of response to checkpoint inhibitors as well as inform the necessity of chemotherapy.

Ultimately, fully understanding these factors will help the field deliver the best form of precision medicine to their patients, Chiang concludes.

Anne Chiang, MD, PhD, discusses unanswered questions with immunotherapy in non–small cell lung cancer.

Dr. Chiang on Unanswered Questions With Immunotherapy in NSCLC 

Anne Chiang, MD, PhD, professor and thoracic oncologist at Yale Cancer Center, discusses the toxicities with ipilimumab (Yervoy) plus nivolumab (Opdivo) in small cell lung cancer (SCLC). 

The toxicities are similar to what is expected with each drug alone, explains Chiang. Around 70% of patients had treatment-related adverse events (AEs), but many of the toxicities could be easily managed. However, 10% of patients discontinued treatment due to the AEs. 

Anne Chiang, MD, PhD, professor and thoracic oncologist at Yale Cancer Center, discusses the toxicities with ipilimumab (Yervoy) plus nivolumab (Opdivo) in small cell lung cancer (SCLC).

Dr. Chiang on Toxicities with Ipilimumab Plus Nivolumab in Small Cell Lung Cancer

Anne Chiang, MD, PhD, professor and thoracic oncologist at Yale Cancer Center, discusses ipilimumab (Yervoy) plus nivolumab (Opdivo) in small cell lung cancer (SCLC).

This combination is now included in the National Comprehensive Cancer Network (NCCN) guidelines for this indication, but it not yet FDA approved.

Chiang says that although the lack of approval raises questions as a clinician, the impact of this immunotherapy combination is a tremendous milestone for SCLC.

Anne Chiang, MD, PhD, professor and thoracic oncologist at Yale Cancer Center, discusses ipilimumab (Yervoy) plus nivolumab (Opdivo) in small cell lung cancer.

Dr. Chiang Discusses Ipilimumab Plus Nivolumab in Small Cell Lung Cancer

Anne Chiang, MD, PhD, professor and thoracic oncologist at Yale Cancer Center, discusses immunotherapy in specific patient populations with lung cancer.

Not all patients are going to respond to immunotherapy, explains Chiang. Right now, the patient population that has a tumor proportion score of greater than 50% will likely experience a greater benefit with immunotherapy.

For those in the 1% to 49% range, we are not sure what the right answer is, says Chiang. It is important to conduct further clinical trials in that patient population.

Dr. Chiang on Immunotherapy in Patient Populations for Lung Cancer

Anne Chiang, MD, PhD, professor and thoracic oncologist at Yale Cancer Center, discusses molecular testing in lung cancer and how it affects treatment decisions.

There are currently 3 approved immunotherapy agents approved for lung cancer: pembrolizumab (Keytruda), nivolumab (Opdivo), and atezolizumab (Tecentriq). If molecular testing shows a high level of PD-L1, patients are typically started on pembrolizumab, says Chiang.

However, not all patients across the country are being tested. Those who are not tested typically start treatment with nivolumab, when they could be seeing more benefit with pembrolizumab.

View more from the 2016 New York Lung Cancer Symposium