Gregory A. Otterson, MD

Gregory A. Otterson, MD, professor of internal medicine, associate division director for Education, co-director of the Thoracic Oncology Program for the Division of Medical Oncology, and associate director for the Hematology and Medical Oncology Fellowship Program, The Ohio State University Comprehensive Cancer Center—The James, discusses data examining immunotherapy alone versus in combination in non–small cell lung cancer (NSCLC).

The phase 3 KEYNOTE-407 study looked at the data of chemotherapy plus immunotherapy or chemotherapy alone in patients with NSCLC, says Otterson. This study showed that chemotherapy plus immunotherapy was better than chemotherapy alone. After a median follow-up of 7.8 months, the median overall survival was 15.9 months (95% CI, 13.2-not reached) in the pembrolizumab-combination group and 11.3 months (95% CI, 9.5-14.8) in the placebo-combination group (HR, 0.64; 95% CI, 0.49-0.85; 

However, physicians still do not know how chemotherapy plus immunotherapy compares with immunotherapy alone in patients with NSCLC who have a greater than 50% PD-L1 expression. For those who have a PD-L1 expression of greater than 50% they should be given pembrolizumab alone and for those who fall within the 0% to 49% of PD-L1 expression, they should be given chemotherapy plus pembrolizumab, concludes Otterson.

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Gregory A. Otterson, MD, discusses data examining immunotherapy alone versus in combination in non–small cell lung cancer.

Dr. Otterson on the Utility of Immunotherapy in NSCLC

Gregory A. Otterson, MD, professor of internal medicine, associate division director for Education, co-director of the Thoracic Oncology Program for the Division of Medical Oncology, and associate director for the Hematology and Medical Oncology Fellowship Program, The Ohio State University Comprehensive Cancer Center—James, discusses when to start treatment with immunotherapy in patients with non–small cell lung cancer.

Before starting a patient on immunotherapy or chemoimmunotherapy, it is important to have identified whether they harbor a targetable mutation, says Otterson.

In general, waiting to start immunotherapy until genetic testing results are analyzed optimizes treatment and spares patients from unnecessary toxicities, explains Otterson.

For example, patients who receive chemoimmunotherapy may develop severe hepatitis if they switch to a targeted therapy such as osimertinib (Tagrisso) in the presence of an 

Chemotherapy alone can be given to patients who require immediate treatment. Immunotherapy can be added into the second cycle of therapy if testing for 

 comes back negative, concludes Otterson.

Gregory A. Otterson, MD, discusses when to start treatment with immunotherapy in patients with non–small cell lung cancer.

Dr. Otterson on When to Start Immunotherapy in NSCLC

Gregory A. Otterson, MD, professor of internal medicine, associate division director for Education, co-director of the Thoracic Oncology Program for the Division of Medical Oncology, and associate director for the Hematology and Medical Oncology Fellowship Program, The Ohio State University Comprehensive Cancer Center—The James, discusses targetable biomarkers in non–small cell lung cancer (NSCLC).

Four actionable biomarkers exist in lung cancer: 

; all of them have FDA approved drugs that are very effective. The agents targeting 

 alterations are often discussed, as they have shown the most activity. The first 2 drugs that were approved were crizotinib (Xalkori) and ceritinib (Zykadia) for use in previously untreated patients with metastatic 

-positive NSCLC; however, they are not used as often as they used to be, since the next generation of drugs have emerged in the treatment landscape.

Alectinib (Alecensa), brigatinib (Alunbrig), and lorlatinib (Lorbrena) received subsequent approval for use in this patient population, says Otterson, and these agents appear to have much greater activity and tolerability. When alectinib and brigatinib were compared with crizotinib in the first-line setting, they both showed much better progression-free survival as well as improved central nervous system penetration and control. Additionally, a study comparing lorlatinib with crizotinib has completed accrual. The real question that all investigators hope to answer is how the newer agents compare with one another; however to date, the answer is unknown, concludes Otterman.

Gregory A. Otterson, MD, discusses targetable biomarkers in non–small cell lung cancer.

Author | Gregory A. Otterson, MD

Articles

Dr. Otterson on the Utility of Immunotherapy in NSCLC

Dr. Otterson on When to Start Immunotherapy in NSCLC

Dr. Otterson on Targetable Biomarkers in Lung Cancer