Mark W. Kris, MD
It has been an explosion of immunotherapy and targeted agents over the last few years for patients with non–small cell lung cancer (NSCLC), according to Mark W. Kris, MD.
FDA-approved immunotherapy options, such as nivolumab (Opdivo) and pembrolizumab (Keytruda), and others moving through the pipeline, such as atezolizumab (Tecentriq), have demonstrated long-lasting benefits in lung cancer. Meanwhile, other agents, such as bevacizumab (Avastin), ramucirumab (Cyramza), and necitumumab (Portrazza), among others, are also advancing the field.
Kris, a medical oncologist at Memorial Sloan Kettering Cancer Center, discussed immunotherapy, frontline therapies for nonsquamous NSCLC, and advancements in squamous cell carcinoma during a lecture at the OncLive
State of the Science Summit on Metastatic Non–Small Cell Lung Cancer in Cleveland, Ohio.
In an interview with OncLive
during the meeting, Kris touched upon all of these areas of research and reflected on how the treatment paradigm has dramatically evolved across subgroups of patients with lung cancer.
OncLive: What were the main points in your lecture on immunotherapy in NSCLC?
: We spoke about the role of immune approaches in the treatment of patients with lung cancers. People have tried to find a way to rev up the immune system to fight all cancers for more than 100 hundred years. Up until now, it has been a goal or a dream, and only recently are we able actually to deliver on that for patients with lung cancer.
What we have seen are agents that target PD-1/PD-L1, and now agents that target anti–CTLA-4 are very helpful in leading to dramatic benefits for patients with lung cancer. There is very clear evidence that, particularly for nivolumab and pembrolizumab, they improve rates of shrinkage and improve duration of survival—which is an extremely impressive result—over standard chemotherapy. In the trials that have been done thus far for both of those agents, as well as atezolizumab, the agents have been compared with docetaxel.
Moreover, equally as important to those benefits in outcome are the benefits in terms of severe side effects, because approximately half of patients who receive docetaxel get some kind of a severe side effect. Now, only about 10% of patients who receive immunotherapies get those side effects, so it has everything going for it. In the last year, virtually every single patient with progressive disease who receives initial therapy—either pembrolizumab or nivolumab, and probably shortly atezolizumab—is going to be recommended for these patients.
What we learned at the 2016 ASCO Annual Meeting this year, and following up on reports at a lot of different meetings, is regarding the combination of these drugs with anti–CTLA-4 drugs. There was one presentation by Dr Matthew Hellman regarding the trials with nivolumab and ipilimumab. They were comparing it to patients in these same trials who received nivolumab with higher rates of response, longer durations of response, and better survival. Also, by adjusting the dosages and schedules of ipilimumab and nivolumab, results showed very good tolerance, and truly almost the same degree of side effects with the combination as nivolumab alone.
Additionally, if you had high PD-L1 expression, you had a very good chance of having a response. Again, this is in a minority of patients but, for those who have it, it’s almost a sure thing that they’re going to have a response. What many people thought was the most amazing finding was that a number of people on that trial had no growth of their cancer after years of treatment. Some of them have come to surgery to remove what was left after years of treatment on those studies, and what they found is nothing— just scar tissue. Therefore, the benefits in the short term, in terms of response and fewer side effects and the chance for long survival, make these regimens very appealing.