Benjamin P. Levy, MD
Researchers are looking to further improve outcomes in non–small cell lung cancer (NSCLC) through a novel regimen of immunotherapy, angiogenesis inhibition, and chemotherapy—a synergistic combination that Benjamin P. Levy, MD, says would be exciting to have in the landscape.
Levy, assistant professor of oncology, clinical director, Medical Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Sibley Memorial Hospital, expanded on these strategies and highlighted other trials that continue to shape the treatment landscape for patients with lung cancer.
OncLive: Can you discuss the data we have with frontline pembrolizumab and chemotherapy from the KEYNOTE-189 trial?
What we know right now is that single-agent pembrolizumab is the standard of care for patients with a PD-L1 score greater than 50% in advanced-staged patients. However, there are new data emerging from KEYNOTE-189, which is a randomized phase III trial comparing carboplatin/pemetrexed versus carboplatin/pemetrexed with the addition of pembrolizumab.
They are likely to be presented at either the 2018 AACR Annual Meeting or the 2018 ASCO Annual Meeting. In that trial, I’m interested to see the outcomes for the patients who had a PD-L1 score greater than 50% and the outcomes for the patients who had a PD-L1 score less than 50%. For the right patients, having these drugs available as single agents in the chemotherapy-refractory and upfront settings is going to be beneficial. We're all very interested and excited to see the data as they unfold.
What other combination regimens are showing promise?
The IMpower150 trial is a 3-arm trial that has been recently presented but not yet published, looking at the standard regimen of carboplatin/paclitaxel and bevacizumab (Avastin) as the control arm. This was compared to 2 other arms: carboplatin/paclitaxel and bevacizumab with atezolizumab, and carboplatin/paclitaxel and atezolizumab alone. The first analysis compared the ECOG-4599 standard of carboplatin/paclitaxel and bevacizumab to carboplatin/paclitaxel, and bevacizumab with atezolizumab.
What we saw in the data that were presented at the 2017 ESMO Immuno-Oncology Congress, was an improvement in PFS, response rates, and early signals for OS in the intention-to-treat analysis. That benefit was also seen in the patients who were PD-L1 negative. It’s a 4-drug combination, and the jury is still out on how we'll use this. However, it is exciting to see that adding another drug to an existing 3-drug regimen, specifically atezolizumab, may benefit patients.
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