Second-Line Therapy for Stage IV NSCLC
Second-line treatment recommendations for patients with stage IV non–small cell lung cancer who experience disease progression after immunotherapy.
EP: 1.Frontline Treatment of PD-L1+ Stage IV NSCLC: Cemiplimab
EP: 2.Frontline I-O Monotherapy Versus Combination Therapy for PD-L1+ Stage IV NSCLC
EP: 3.Frontline Treatment of Stage IV NSCLC: IPI/NIVO
EP: 4.Frontline Treatment Decisions for Stage IV NSCLC
EP: 5.Frontline Treatment of Stage IV NSCLC: Biomarkers
EP: 6.Immune-Related Adverse Events in NSCLC
EP: 7.Frontline Treatment of Stage IV NSCLC: What’s Next?
EP: 8.Second-Line Therapy for Stage IV NSCLC
EP: 9.Durvalumab for Unresectable Stage III NSCLC
EP: 10.Risks of Pneumonitis in Unresectable Stage III NSCLC
EP: 11.Appropriateness for Durvalumab in Unresectable Stage III NSCLC
EP: 12.CRT and I-O for Unresectable Stage III NSCLC
EP: 13.Neoadjuvant Immunotherapy for Resectable NSCLC
EP: 14.Clinical Endpoints and Neoadjuvant Therapy for Resectable NSCLC
EP: 15.Atezolizumab After Adjuvant Chemotherapy in Resectable NSCLC
EP: 16.Biomarkers for Immunotherapy in Resectable NSCLC
EP: 17.Perioperative Approaches to NSCLC
EP: 18.Blood-Based Biomarkers in NSCLC
EP: 19.Immunotherapy for NSCLC: Clinical Pearls
Mark A. Socinski, MD: Before we move on, I want to go back to Neal. Essentially what we’ve done here is take what we used to do in the second line, which was immuno-monotherapy, and graft it on to standard first-line regimens. We combined first- and second-line standards in this setting. We’ve had a nice discussion about how successful that strategy was, but what do you do afterward? What do you do now in the second-line setting for these patients? The vast majority of patients are getting [chemotherapy/immunotherapy] combinations in the first-line setting. What do you do afterward?
Neal Edward Ready, MD, PhD: Thanks, Mark. Of course we’re trying to use clinical trials to figure out how to overcome immune resistance. When that’s not possible, for patients who have seen single-agent IO [immunotherapy], we’re going back to a platinum doublet, where patients who received chemotherapy/IO initially, we’re falling back on docetaxel, sadly. But I think that some of the progress we’ve made in KRAS, which you know KRAS tumors often do respond to immunotherapy, but they often eventually progress. The advent of targeted therapy for KRAS G12C gives us another option. Hopefully we’ll have more molecular therapies for some of these immune responsive tumors.
Mark A. Socinski, MD: It’s very nice after many years of not having a KRAS strategy, at least for a portion of the patients with KRAS [mutations], we do have a new option, which the recent data updated at ASCO [American Society of Clinical Oncology annual meeting] on the CodeBreaK 100 trial looked pretty promising. The only thing I would add is don’t forget about anti-VEGF in the second-line setting. I do use a lot of ramucirumab with docetaxel in this particular setting.
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