Dr. Patel on the Role of CTLA-4 Inhibitors in NSCLC

Manish Patel, DO, hematologist, oncologist, associate professor of medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, discusses the role of CTLA-4 inhibitors in non–small cell lung cancer (NSCLC).

Although it is difficult to determine when to include a CTLA-4 inhibitor in treatment regimens for patients with NSCLC, the chemotherapy-free option of nivolumab (Opdivo) plus ipilimumab (Yervoy) is preferable in some cases compared with chemotherapy, Patel explains. If a patient has PD-L1–negative disease or intermediately expresses PD-L1, the nivolumab plus ipilimumab combination could mitigate chemotherapy-related toxicities, Patel explains. However, it can be sometimes difficult to determine which patients require chemotherapy and who will benefit from the addition of a CTLA-4 inhibitor without significant toxicity, Patel adds.

 Being able to understand which patients will benefit from the combination will spare many patients from unnecessary toxicities and will be cost-effective for health care overall, Patel continues. Moreover, identifying which patients do not require chemotherapy up front will guide treatment decisions, Patel concludes.