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Immunotherapy in Chemorefractory Lung Cancer

Benjamin P. Levy, MD
Published: Thursday, Apr 06, 2017



Transcript:

Benjamin P. Levy, MD:
Off of a clinical trial, I would say that patients who have received chemotherapy and their tumors are growing should be considered as candidates for immunotherapy. Not all patients will be candidates for immunotherapy, but we do, now, have 3 drugs that we can use—nivolumab (Opdivo), pembrolizumab (Keytruda), and atezolizumab (Tecentriq) have all shown survival advantages.

Two of these drugs can be used independent of PD-L1 testing in the chemorefractory setting—that’s Opdivo and Tecentriq (or nivolumab and atezolizumab). And 1, pembrolizumab, can be used for tumor proportion scores greater than 1%.

I think it’s routine, now, for patients that are chemorefractory and are no longer deriving a benefit from chemotherapy (either in terms of they can’t tolerate it or their tumor is not responding), that we should consider, off of a clinical trial, immunotherapy. I’ve yet to use pembrolizumab upfront. I have not, yet, identified a tumor proportion score greater than 50%. I’m not sure why that is. They’re out there—in the literature, it’s 25% of patients. Keep in mind, this data just came out 3 or 4 months ago and I’ve switched institutions, so I’m a little lagged behind in terms of the clinical practice (in terms of the patients that I’m seeing). But, I know, soon, I will find somebody with a tumor proportion score of greater than 50%. I just haven’t had it yet.

Transcript Edited for Clarity
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Transcript:

Benjamin P. Levy, MD:
Off of a clinical trial, I would say that patients who have received chemotherapy and their tumors are growing should be considered as candidates for immunotherapy. Not all patients will be candidates for immunotherapy, but we do, now, have 3 drugs that we can use—nivolumab (Opdivo), pembrolizumab (Keytruda), and atezolizumab (Tecentriq) have all shown survival advantages.

Two of these drugs can be used independent of PD-L1 testing in the chemorefractory setting—that’s Opdivo and Tecentriq (or nivolumab and atezolizumab). And 1, pembrolizumab, can be used for tumor proportion scores greater than 1%.

I think it’s routine, now, for patients that are chemorefractory and are no longer deriving a benefit from chemotherapy (either in terms of they can’t tolerate it or their tumor is not responding), that we should consider, off of a clinical trial, immunotherapy. I’ve yet to use pembrolizumab upfront. I have not, yet, identified a tumor proportion score greater than 50%. I’m not sure why that is. They’re out there—in the literature, it’s 25% of patients. Keep in mind, this data just came out 3 or 4 months ago and I’ve switched institutions, so I’m a little lagged behind in terms of the clinical practice (in terms of the patients that I’m seeing). But, I know, soon, I will find somebody with a tumor proportion score of greater than 50%. I just haven’t had it yet.

Transcript Edited for Clarity
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TitleExpiration DateCME Credits
Community Practice Connections™: ALK-Positive NSCLC: Emerging Strategies to Inform Sequencing, Optimize Outcomes, and Address Unmet Clinical Needs Along the Disease ContinuumAug 29, 20181.5
Community Practice Connections™: Oncogenic Tumor Board in Advanced NSCLC: Leveraging Actionable Mutations Along the Disease Continuum to Optimize Patient OutcomesAug 30, 20182.0
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