Hossein Borghaei, DO, MS
Recent clinical trial findings are helping thoracic oncologists choose optimal immunotherapy treatments for their patients with non–small cell lung cancer (NSCLC), but Hossein Borghaei, DO, MS, stressed the importance of more effective biomarkers and sequencing criteria.
State of the Science Summit on Advanced Non–Small Cell Lung Cancer, Borghaei, chief, Division of Thoracic Medical Oncology, director, Lung Cancer Risk Assessment, associate professor, Department of Hematology/Oncology, Fox Chase Cancer Center, discussed immunotherapy selection in NSCLC.
OncLive: What are some of the latest data with immunotherapy in NSCLC?
All the rage with this area has been immunotherapy combinations with chemotherapy. We are seeing some really exciting results with NSCLC, and now even in small cell lung cancer. There are a couple of issues. Many checkpoint inhibitors, mostly PD-1/PD-L1 antibodies, have been combined with chemotherapy drugs. They are all showing pretty uniform responses. There have been some varying chemotherapy backbones.
There have been some data with quadruplet therapies, but we have to be careful when considering this. Four-drug regimens are not for everyone who walks through the door of your clinic. It's a thought-provoking time. For my patients, I would always use a chemotherapy backbone that I know is a little less toxic. Every time we use 2, 3, or 4 drugs, we know there is additional toxicity. The question then becomes, "Is chemotherapy plus immunotherapy for everyone?"
What are some factors to consider when deciding the right regimen for a patient?
I would say that, for a very symptomatic patient who needs aggressive therapy, a chemotherapy combination with a checkpoint inhibitor is a good idea. You're going to get a good response rate. If you have someone with metastatic disease but low tumor mutational burden, single-agent chemotherapy would work in that space. KEYNOTE-042 is a good trial to look at for reference.
By and large, you need to look at this on a patient-by-patient basis. The field is going to evolve even more beyond this, and further research will clarify the idea of sequencing treatments and patient selection. We can hopefully get a more effective biomarker.
What has been the biggest success thus far, and how can researchers compound this success into further advancements?
The biggest success has definitely been identifying immunotherapy. We have 2 Nobel Prize winners in medicine for identifying checkpoint inhibitors as therapeutic targets. However, the field of immunology is very young. There is still a lot that we don't know. We're seeing wonderful clinical efficacy without understanding the biology behind it. Once we collaborate with the science side and understand how the immune system works and how we can manipulate it, this will make a huge difference.
Lopes G, Wu YL, Kudaba I, et al. Pembrolizumab (pembro) versus platinum-based chemotherapy (chemo) as first-line therapy for advanced/metastatic NSCLC with a PD-L1 tumor proportion score (TPS) ≥1%: open-label, phase 3 KEYNOTE-042 study. J Clin Oncol. 2018;36 (suppl; abstr LBA4).
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