Dr. Dietrich on Navigating the NSCLC Treatment Landscape

Martin Dietrich, MD, PhD, shares how he navigates the non–small cell lung cancer (NSCLC) treatment landscape.

Martin Dietrich, MD, PhD, assistant professor, University of Central Florida, fellow, American College of Physicians, Florida Cancer Specialists & Research Institute, shares how he navigates the non–small cell lung cancer (NSCLC) treatment landscape.

Because the regimens examined in the phase 3 KEYNOTE-189 (NCT02578680) and KEYNOTE-407 (NCT02775435) trials are so broadly applicable, they have shifted focus away from utilizing biomarkers to guide treatment for patients with NSCLC, according to Dietrich. The long-term effect of these regimens remains highly dependent on PD-L1 expression levels, and an incremental benefit is observed the higher the PD-L1 expression is, Dietrich says. In the PD-L1–negative population, single-agent PD-1 inhibitors do not have a lasting effect. As such, for these patients, combination strategies must be explored, Dietrich adds. 

In terms of patients with PD-L1–high disease, the combination of ipilimumab (Yervoy) plus nivolumab (Opdivo) has received regulatory approval, and has been shown to provide an absolute survival benefit of 10% at 4 years compared with nivolumab alone, Dietrich adds. Looking forward, TIGIT antibodies will be integral in enhancing PD-L1–positive expression, Dietrich concludes.

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