Corey J. Langer, MD
Treatment in lung cancer continues to evolve at a rapid pace with the arrival of a set of efficacious new agents and promising evidence-based data. According to Corey J. Langer, MD, a veritable avalanche of additional data is on the way.
“There’s certainly a lot of exploration expanding immunotherapy to the first-line setting, both as single agents for those who are enriched for PD-L1, but also in combination in all-comers with other immunotherapy approaches, as well as with standard platinum-based chemotherapy,” said Langer, a professor of Medicine at the Perelman School of Medicine and director of Thoracic Oncology at the University of Pennsylvania.
In an interview with OncLive
at the 34th Annual Chemotherapy Foundation Symposium
™ (CFS), Langer discussed some of this groundbreaking data, novel combinations potentially on the horizon, and much more in the field of lung cancer.
OncLive: What did you discuss at the CFS?
: I focused on squamous cell advanced non–small cell lung cancer (NSCLC). I summarized the therapeutic landscape, which really begins first with cytotoxic, so gemcitabine and taxanes combined with platinum. We’ve now seen the emergence of nanoparticle-bound paclitaxel, which seems to have advantages over conventional taxanes in this setting.
And more recently, the addition of EGFR monoclonal antibodies—necitumumab (Portrazza) in combination with gemcitabine/platinum—is clearly looking better than chemotherapy alone. And ramucirumab (Cyramza) in the second-line setting offers a survival advantage in combination with docetaxel (Taxotere) versus docetaxel alone.
But probably the most striking data are really for immunotherapy, certainly in the second-line setting, where nivolumab bested docetaxel. The response rates were more than double—20% or 21% versus 8% or 9%. Progression-free survival (PFS) was 50% higher for nivolumab (Opdivo) versus docetaxel, and median survival was at least 3 to 4 months better, and about 10% to 15% better at 1 year for nivolumab compared to docetaxel.
We also have extraordinarily striking P-values and hazard ratios in the CheckMate-017 trial, which focused exclusively on squamous cell, and had an immediate effect on standard practice, and overnight, we shifted from docetaxel to immunotherapy second-line in squamous cell.
Could you discuss CheckMate-017 in detail?
CheckMate-017 was based on phase I and phase II data that showed promise, both in response in selected patients, and in prolonged PFS in individuals who received nivolumab—not just second-line, but third-, fourth-, even fifth-line. This was specifically in the second-line setting—individuals who had been exposed to a platinum-based combination who had had disease progression. CheckMate-017 randomized 1:1 between nivolumab and docetaxel and had striking results, major improvement in response rate, progression-free, and overall survival. And this really secured the place of immunotherapy in the second-line setting.