Ronald J. Scheff, MD: As we develop more and newer and better treatments in non—small cell lung cancer, I think it’s going to be important to see and study how the antiangiogenesis drugs that we have may enhance the efficacy of these new classes of medications. For instance, it’s very possible that the antiangiogenesis drugs like ramucirumab and ramucirumab/bevacizumab will enhance the activity of checkpoint inhibitors and also will enhance the activity of tyrosine kinase inhibitors.
So, we have preliminary data showing that. I look forward to more data of using bevacizumab and ramucirumab in combination with the newer drugs that we have. I also think that there needs to be further study of the antiangiogenesis agents that we have in earlier stages of disease. We have so many; right now, the standard of care for stages 1, 2, and 3 disease, for systemic therapy, would be chemotherapy. But we’re rapidly coming to a point where we may incorporate targeted therapies, immunotherapies, and I think we need to take another look at the antiangiogenesis, anti-VEGF therapies as well.
Ann Tsao, MD: One of the most critical elements is finding biomarkers that predict for antiangiogenic agents. And I can’t say that we have clear validated biomarkers yet, but the field is rapidly evolving and that is one area of research that we will need to focus on. The second major area is going to be looking at the combination of our antiangiogenics with immunotherapies. There’s already a slight signal that we see that there may indeed be a clinical synergistic benefit. So, both of these are areas that are moving forward rapidly, and hopefully we’ll begin to see some of the results of that within the next year or two.
Benjamin P. Levy, MD: Besides antiangiogenesis research and where antiangiogenic drugs will play a role in the future, I really am excited about the role of immunotherapy in earlier-stage disease, immunotherapy and targeted therapies. There are multiple trials that are going on right now looking at immunotherapy in resectable lung cancer. We just had data published in the New England Journal of Medicine looking at immunotherapy post-concurrent chemoradiation that has led to an approval. But I think we need to move the bar further and understand how both immunotherapy and targeted therapies can cure patients, and whether antiangiogenesis added to these agents will augment that is unclear. And I think we’ll have some studies looking at the combination as well in the curative setting.
It’s great that we’re making meaningful improvements in outcome for stage 4 and even stage 3, but we really want to cure patients. If we want to cure patients, we have to start thinking about good designs of trials looking at these drugs either before surgery or after surgery or before chemoradiation—of course, now we have it after chemoradiation for immunotherapy.
Transcript Edited for Clarity