Insights From: Roy S. Herbst, MD, PhD, Yale School of Medicine; Corey J. Langer, MD, University of Pennsylvania; Vassiliki A. Papadimitrakopoulou, MD, University of Texas MD Anderson Cancer Center
Vassiliki A. Papadimitrakopoulou, MD: ECHO-202 is a combination therapy of epacadostat and pembrolizumab in patients that are immunotherapy naïve with non–small cell lung cancer. Very early results are encouraging. We’re seeing response rates in the range of 30% to 40%, and we’re seeing it turning toward more benefit for patients with high PD-L1 expression.
Roy S. Herbst, MD, PhD: The IMpower trials are trials that are looking at atezolizumab and atezolizumab in combination with chemotherapy. These trials basically look at atezolizumab with carboplatin, paclitaxel, and bevacizumab, for example. There’s a trial that we’ve run at our site at Yale. Dr. Kert Sabbath, my colleague, has been the lead on the trial. We’ve seen some great responses because it makes sense—you know you have the chemotherapy with bevacizumab, which already was a superior regimen, but now you have the immunotherapy on board, and we know there seems to be some synergy between anti-VEGF antibodies and immunotherapy. So, we’re very excited about this trial. These trials have fully accrued and now we’re simply just waiting for their results.
Immunotherapy hasn’t been the best, as of yet, for EGFR-mutated lung cancer, especially when it’s refractory to small molecule inhibitors, probably because those tumors are driven by a single driver and there’s a large antigen mode. And we know that does predict who responds best to immunotherapy. I don’t think the story’s completely written yet. I think there are going to be some roles for, perhaps, combinations of immunotherapy in this setting. There are trials, now, that are looking at nivolumab and ipilimumab in this setting. I think we’ll see some of those trials ongoing, now and in the future. I also think there will be other attempts, as time goes forward, to try to combine an immune therapy and an EGFR agent. There were some issues, early on, in trials because of dual interstitial lung disease, pneumonitis, and skin issues that are seen with these 2 agents. But I think that, perhaps, testing it in other populations will be helpful.