Future Directions in NSCLC Immuno-Oncology Research
Panelists: Everett Vokes, MD, University of Chicago Medicine and Biological Sciences; Roy Herbst, MD, PhD, Yale Cancer Center; Fred Hirsch, MD, PhD, University of Colorado School of Medicine; Suresh Ramalingam, MD, Winship Cancer Institute Emory University; Naiyer Rizvi, MD, Columbia University Medical Center
Everett Vokes, MD: This has been a wonderful, informative discussion. I really want to thank all of you. Before we end, how about each of you provide some final closing thoughts? Let’s start with Roy.
Roy Herbst, MD, PhD: It’s certainly been an exciting year. The evolution of lung cancer therapy truly is progressing. And certainly, the targeted therapy era is as strong as ever with the next generation of EGFR and ALK agents. We have a challenge ahead of us as we try to figure out what to do for resistance in those patients. But it’s a good problem to have. And then, immunotherapy really has taken over as the other alternative for patients without drivers. I would contest that we’re going to have to figure out how to integrate that into some of the patients with driver mutations in the future. But, really, it’s a good era, now, to do trials. We’re seeing benefit.
As you think about things, it’s the perfect time to do thoracic research because we’re seeing benefit in patients. I think we all probably have patients who are alive today, that wouldn’t have been before, because they’ve received immunotherapy either up front or in the second- or third-line setting. And now, the challenge is with the 70% or 80% who aren’t benefiting as much as we’d like. How are we going to help them? And that’s going to be through combinations. It’s going to be through some clinical trials and some science—working with the immunologists and the preclinical scientists to bring some of these new combinations together.
It’s also going to happen through working with industry. Lung-MAP, that we talked about today, is an example of a public-private partnership—collaboration among cooperative groups with industry, with the patient as our ultimate goal.
Everett Vokes, MD: Fred?
Fred Hirsch, MD, PhD: Yes, I absolutely agree with Roy. I would like to make a couple of other points. Scientific achievements and progress in treatment results comes through clinical trials. And unfortunately, still, particularly in the United States, we have quite a low recruitment of patients into clinical trials. I would like to see a jump in that recruitment rate. I would like to see many more patients going into clinical trials. I think, also, there are figures that many clinical trials are concentrated in a few states. I think we need to make a push to bring clinical trials out to communities and the areas where the bulk of patient cases occur. And those 2 things are, of course, something that IASLC is currently working on. But we need to make it clear that clinical progress, therapeutic progress, comes through clinical trials. We should offer clinical trials to more patients.
Everett Vokes, MD: Ram [Suresh]?
Suresh Ramalingam, MD: I agree with the others that this is an exciting time. We’ve just seen all the new data, and the 2 trials that stand out to me are the PACIFIC trial and the FLAURA trial. The PACIFIC trial introduces a new exciting advance into stage 3 disease, and we’re going to be talking a lot about that in the coming months. I think our patients are going to be better off because of these advances, and I look forward to seeing the results of the chemotherapy plus immune checkpoint inhibitor trials in the upcoming months as the next potential important step forward.
Everett Vokes, MD: Naiyer?
Naiyer Rizvi, MD: I think this was a great discussion. I think we now have 5-year data with PD-1s showing a little more than a 15% response rate. We even say the word “cure,” from time to time, for a patient with metastatic disease. We never could have whispered that before. Seeing all of these advances in advanced stage, as well as local-advanced, early-stage disease makes me confident that we’re going to keep curing more patients.
Everett Vokes, MD: Yes, I agree. It’s a really exciting time. This week, just hearing about the FLAURA and the PACIFIC trials was very exciting. Also, the evolution of ALK therapy, where you go from a target discovered just about 10 years ago to now—with not 1 drug or 2, but multiple agent—each one seems to be getting a little bit better than the one before. That is very exciting, and it supports your concept that clinical trials are necessary for us to make progress.