Immunotherapy Options for Lung Cancer Variations

Transcript:Yasushi Goto, MD, PhD: In Japan, after approval of the drugs, reimbursement was virtually equal. After approval of pembrolizumab, we received access to the first-line treatment for patients with PD-L1 [programmed death-ligand 1], which occurs in more than 50% of patients with tumor cells. After that, every patient was tested for PD-L1. We are trying not to lose any chance to administer pembrolizumab first line. We believe from the data that if we can select patients for PD-L1 inhibitors, that they will receive more benefit than from chemotherapy alone. Of course, conventional chemotherapy works on that cohort as well, even after they relapse or after the response to the immunotherapy. We still think that the first line should be pembrolizumab. We’re trying hard to give patients that chance.

Regarding the PACIFIC trial, we were happy to see the overall benefit in the phase II lung cancer because we haven’t made many advancements in that stage. We are already using PD-L1 inhibitors, so there’s no problem with prescribing those treatments to patients; however, we also have to be mindful of radiation, since it has pneumonitis, which will be exaggerated by PD-L1 inhibitors. We have to take care that we begin with the patients who are metastatic with PD-L1, after which we start with chemoradiotherapy and post chemoradiotherapy, so we can use the experience from the patients who are metastatic and progress to the new experience of using chemoradiotherapy.

In Japan we administer 4 cycles of chemotherapy, even after consultation chemotherapy and chemoradiotherapy; however, there is evidence suggesting shorter cycles of durvalumab after radiotherapy is better. We are relying on administering durvalumab after 2 cycles of chemoradiotherapy—giving it as soon as possible. At this time, we don’t have enough experience with radiation pneumonitis during durvalumab.

It’s challenging because we give radiation with some kind of necessity. It’s difficult to evaluate whether the radiation or durvalumab was the effective agent. We are working hard to see whether durvalumab is useful for that patient population.

Transcript Edited for Clarity.

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