Simon Says Immunotherapy Combo Regimens on Horizon in NSCLC

Immunotherapy continues to show single-agent efficacy in non–small cell lung cancer (NSCLC) and is now being investigated in combination regimens to further improve patient outcomes.

Frontline treatment with the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) is currently being assessed in the phase III CheckMate-227 study (NCT02477826). This 4-arm study is comparing nivolumab versus nivolumab plus ipilimumab versus nivolumab plus platinum-doublet chemotherapy versus platinum-doublet chemotherapy alone. This trial is currently accruing patients with stage IV NSCLC and will be completed in 2020.

“This combination is being investigated in multiple other diseases across the board, including small cell lung cancer (SCLC) and mesothelioma and other non-thoracic diseases,” said George R. Simon, MD.

In another realm of the lung cancer spectrum, the addition of osimertinib (Tagrisso) to the EGFR–positive armamentarium has garnered excitement among physicians, most recently with the phase III results of the FLAURA trial. Here, osimertinib’s benefit in the frontline setting was showcased in comparison to the first-generation EGFR inhibitors gefitinib (Iressa) and erlotinib (Tarceva). The agent is currently FDA approved in the second-line setting for patients who harbor the T790M resistance mutation, but now has a breakthrough therapy designation with the FDA to be used as a frontline agent for EGFR-positive patients.