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Manish R. Patel, DO, discusses current questions and research regarding immunotherapy in non–small cell lung cancer.
Manish R. Patel, DO, hematologist/oncologist, Masonic Cancer Clinic, discusses current questions and research regarding immunotherapy in non—small cell lung cancer (NSCLC).
Currently, there are 2 FDA-approved first-line chemoimmunotherapy regimens, which comprise pembrolizumab (Keytruda) with chemotherapy as well as a 4-drug regimen comprising atezolizumab (Tecentriq), bevacizumab (Avastin), and carboplatin/paclitaxel. Currently, it is hard to know who might benefit from the addition of bevacizumab, explains Patel. Patients with liver metastases or patients with EGFR mutations who have failed TKIs seem to benefit from bevacizumab, according to Patel.
In order to understand why bevacizumab might help with response to immunotherapy, Patel believes physicians need to gather more data about the immunologic effects of VEGF-targeted therapy and trying to understand what patients might benefit the most.
Results of the KEYNOTE-024 trial showed that patients with NSCLC and high PD-L1 expression benefit from pembrolizumab monotherapy compared with chemotherapy alone. However, an unanswered question is whether combination of chemotherapy and immunotherapy is beneficial compared with immunotherapy alone in that patient population. Some ongoing studies will help answer those questions, Patel concludes.