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Borghaei Shares Insight on Immunotherapy in NSCLC

Brandon Scalea
Published: Wednesday, Oct 24, 2018

Hossein Borghaei, DO

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?

Borghaei: 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.
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