Practical Application of Recent Clinical Data for Immunotherapy in NSCLC - Episode 8

Experience With I-O Therapies in Second-Line NSCLC


Leora Horn, MD, MSc, FRCPC: Tom, different checkpoint inhibitors are approved. In the first-line setting, pembrolizumab is approved right now. In the second-line setting, we have nivolumab, pembrolizumab, and atezolizumab as monotherapy. Do you see any differences between these different drugs?

Thomas E. Stinchcombe, MD: I think the second-line immunotherapy-naïve patient population is rapidly declining, in terms of the number of patients we see. But, we do still see them. Most of the time, I don’t think that there’s a strong efficacy or toxicity difference between the 3 therapies. I often decide based on schedule. Nivolumab can be given every 4 weeks. Pembrolizumab and atezolizumab can be given every 3 weeks. I think those factors play more of a role than the differences in the data.

Leora Horn, MD, MSc, FRCPC: Yes, I think schedule is definitely driving us. You’ve given nivolumab every 4 weeks. I have not. That data came from looking at PK/PD [pharmacokinetics/pharmacodynamics] as opposed to efficacy data. I admit that I’m giving 6 months of therapy every 2 weeks if I’m using it. And then I go to an every 4-week regimen. What are you guys doing? Are you giving this every 4 weeks, with no problems, when you’re using it?

Edward B. Garon, MD: I am using it every 4 weeks. I’m very involved in the CheckMate 384 study, which actually was randomized into that question. I’m not sure that I’ve ever been involved in what will probably be such useless data at presentation, because, in fact, they are now both approved. Unless there’s a huge discrepancy between the 2 of them, I think both of them will continue to be used. I have gone to the every 4-week regimen. When one looks at the dose range on studies to date, there’s very little evidence to indicate that there’s a huge difference. And so, I have comfort in using that every 4-week regimen.

Thomas E. Stinchcombe, MD: I use the every 4-week regimen. Some patients travel a lot. Sometimes they are on this therapy for a long time. It does make the patient’s quality of life better.

Leora Horn, MD, MSc, FRCPC: Absolutely. Twenty-six versus 13 visits a year is a dramatic difference in terms of quality of life.

Edward B. Garon, MD: Anyone who has spent much time on Interstate 405 in Los Angeles would like to come into the clinic less frequently rather than more.

Leora Horn, MD, MSc, FRCPC: Fair enough. Tom sometimes has mountains to travel to get to his cancer center.

Transcript Edited for Clarity