Janakiraman Subramanian, MD

Janakiraman Subramanian, MD, medical oncologist, director of Thoracic Oncology, Center for Precision Medicine, Saint Luke’s Cancer Institute, discusses the IMpower131 trial in advanced squamous non—small cell lung cancer (NSCLC).

In the IMpower131 trial, patients were randomized to receive the combination of carboplatin and paclitaxel plus atezolizumab (Tecentriq) versus carboplatin and paclitaxel plus placebo. This was a complex, 3-arm study, that allowed for 2 different versions of paclitaxel in addition to the placebo arm, says Subramanian. The primary endpoints of the study were overall survival (OS) and progression-free survival (PFS). The results showed a clear benefit in PFS. At the time of the interim analysis, there was no significant difference in OS observed between arms.

It remains to be seen what the subsequent analysis will show, says Subramanian. Notably, at the 1-year interval, survival was not significantly different between 2 arms. However, the 2-year survival seemed to show a separation between the curves. Therefore, there is a group of patients with advanced squamous NSCLC who benefit from chemotherapy and immunotherapy. Determining who these patients are, how to best select them, and deliver the appropriate treatment to them is the key challenge that we will be better addressed once the final results of the study read out, adds Subramanian. Whether this combination will become a standard of care alongside pembrolizumab (Keytruda) and chemotherapy will depend on the final OS data, he concludes.

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Janakiraman Subramanian, MD, medical oncologist, director of Thoracic Oncology, Center for Precision Medicine, Saint Luke’s Cancer Institute, discusses the IMpower131 trial in advanced squamous non–small cell lung cancer (NSCLC).

Dr. Subramanian on the IMpower131 Trial in Squamous NSCLC

Janakiraman Subramanian, MD, a medical oncologist and director of thoracic oncology and director of the Center for Precision Medicine at Saint Luke’s Cancer Institute, discusses tumor biology in lung cancer.

To move the needle forward in both small cell lung cancer (SCLC) and squamous non—small cell lung cancer, physicians have to gain a better understanding of the biology of the disease, explains Subramanian. One way to inform this understanding is through tissue collection, he adds.

However, tissue collection, specifically the quantity and quality of the specimens—especially in SCLC&mdash;are lacking. This stunts any further understanding of how the tumor evolves over time with different treatments, says Subramanian. Implementing a standardized tissue collection protocol could alter the way physicians treat patients with SCLC.

Patient enrollment on clinical trials is another critical component of improving outcomes. Combining biological data with clinical outcomes data is how physicians can continue to move the needle forward, he concludes.

Dr. Subramanian Discusses Tumor Biology in Lung Cancer

Janakiraman Subramanian, MD, a medical oncologist and director of thoracic oncology and director of the Center for Precision Medicine at St. Luke’s Cancer Institute, discusses the future of immunotherapy in non—small cell lung cancer (NSCLC).

The frontline space of NSCLC has been defined by single-agent immunotherapy and immunotherapy in combination with chemotherapy as evidenced by results of the KEYNOTE-042 and IMpower150 trials. Results from additional trials evaluating the use of immunotherapy agents in this space are eagerly awaited, says Subramanian, one of which is examining nivolumab (Opdivo).

However, that leaves an unmet need for patients who progress through these regimens. A lot of effort has been expended defining frontline options for patients, but it is unknown what the best options are following progression, he says. Ongoing studies are looking at new checkpoint inhibitors that are either completely novel or are being used in combination with current immunotherapy therapies, states Subramanian. Other targeted agents are being explored in this space as well.

Janakiraman Subramanian, MD, a medical oncologist and director of thoracic oncology and director of the Center for Precision Medicine at St. Luke’s Cancer Institute, discusses the future of immunotherapy in non–small cell lung cancer (NSCLC).

Dr. Subramanian on the Future of Immunotherapy in NSCLC

Janakiraman Subramanian, MD, medical oncologist, director of Thoracic Oncology, Center for Precision Medicine, Saint Luke’s Cancer Institute, discusses ongoing trials evaluating the use of immunotherapy in patients with nonsquamous non—small cell lung cancer (NSCLC).

At Saint Luke’s Cancer Institute, there are several ongoing trials that are investigating the use of these agents, specifically, the addition of lenvatinib (Lenvima) to the combination of chemotherapy and pembrolizumab (Keytruda). Physicians believe that the addition of the TKI to combination chemoimmunotherapy may be the next step in frontline treatment for these patients, says Subramanian.

Another strategy is attempting to build upon the benefit that has been observed with single-agent immunotherapy, he explains by adding another checkpoint inhibitor, such as a LAG-3 antibody or a TIM-3 monoclonal antibody. TIM-3 is an investigational checkpoint for which there are available targeted agents. Those agents are being tested in combination with a PD-1 inhibitor in the second-line setting for patients who have progressed through immunotherapy, concludes Subramanian.

Janakiraman Subramanian, MD, medical oncologist, director of Thoracic Oncology, Center for Precision Medicine, Saint Luke’s Cancer Institute, discusses ongoing trials evaluating the use of immunotherapy in patients with nonsquamous non–small cell lung cancer (NSCLC).

Author | Janakiraman Subramanian, MD

Articles

Dr. Subramanian on the IMpower131 Trial in Squamous NSCLC

Dr. Subramanian Discusses Tumor Biology in Lung Cancer

Dr. Subramanian on the Future of Immunotherapy in NSCLC

Dr. Subramanian on Ongoing Trials for Patients With Nonsquamous NSCLC