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PD-1 Inhibitors Make Tremendous Impact in NSCLC, But Questions Remain

Laura Panjwani
Published: Thursday, Jan 28, 2016

Renato Martins, MD

Renato Martins, MD

With both nivolumab (Opdivo) and pembrolizumab (Keytruda) approved by the FDA as treatments for patients with nonsquamous non–small cell lung cancer (NSCLC) across all histologies, oncologists now have their choice of PD-1 inhibitors in the second-line setting.

spoke with Renato Martins, MD, medical director for Thoracic/Head and Neck Oncology and Outpatient General Oncology and Hematology at Seattle Cancer Care Alliance.

OncLive: Who is the ideal patient to receive nivolumab?

Martins: Nivolumab is approved as a second-line therapy for all patients with NSCLC. This is not restricted by any expression of PD-L1—which is different than pembrolizumab—which is also approved for this indication.

mutation. Here, the patients who are PD-L1–negative seem to have very good quality response. That reinforces the concept that PD-L1 expression may be a biomarker, but it is certainly not the biomarker that will answer the question regarding these agents.

Is there any possibility of moving it to the first-line setting?

There are a number of trials looking at the issue of combining PD-1 agents with chemotherapy. They may be showing higher response rates than one would expect with chemotherapy alone; the data is still very immature. My take on it is, until we have a very reliable biomarker—which we will in the future—it is going to be hard to move into the first-line setting.

With both pembrolizumab and nivolumab approved in the second-line setting, how do you determine which treatment to use with your patients?

There may be some advantage to using pembrolizumab in terms of the convenience of it being an every 3-week treatment, as opposed to an every 2-week treatment. The per infusion cost of each drug is about the same, so if you are giving it every 3 weeks as opposed to every 2, there is a significant cost savings, overall.
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