George R. Simon, MD
Following the success of single-agent immunotherapy, multiple studies are investigating immunotherapy combination strategies for patients with non–small cell lung cancer (NSCLC), according to George R. Simon, MD.
In a trial combining immunotherapy with chemotherapy, the phase III KEYNOTE-189 study—the confirmatory trial for the May 2017 FDA approval of pembrolizumab (Keytruda) with carboplatin/pemetrexed—demonstrated improved survival in the frontline treatment of patients with nonsquamous NSCLC. Participants received pembrolizumab or placebo in combination with pemetrexed and either cisplatin or carboplatin. The study met both primary endpoints of progression-free survival (PFS) and overall survival (OS).
It was also recently reported that the dual immunotherapy regimen of nivolumab (Opdivo) and ipilimumab (Yervoy) improved PFS compared with chemotherapy in treatment-naïve patients with high tumor mutation burden NSCLC, according to preliminary findings from part 1a of the phase III CheckMate-227 trial.
In an interview during the 2018 OncLive®
State of the Science Summit™ on Advanced Non–Small Cell Lung Cancer, Simon, a professor in the Department of Thoracic/Head and Neck Medical Oncology in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discussed emerging advancements with immunotherapy combination strategies for patients with NSCLC.
OncLive: Please provide an overview of your presentation on frontline combination strategies in NSCLC.
I discussed immunotherapy combinations in the first-line setting for the treatment of patients with NSCLC. These consist of combining immunotherapy with chemotherapy or combining immunotherapy with another immunotherapy agent.
The principal studies that are farthest along in development are the KEYNOTE studies. Principally, cohort G of the KEYNOTE-021 trial, which has already reported out, suggested a significant advantage for combining carboplatin and pemetrexed with pembrolizumab. As a follow-up to that study, there is a larger phase III study called KEYNOTE-189, for which a recent press release suggested that it met its coprimary endpoints of PFS and OS. We have not seen the data yet; I believe that will be presented soon.
Other combination studies are exploring chemotherapy and immunotherapy options. The principal combination of that strategy is atezolizumab (Tecentriq) with various chemotherapy drugs, including carboplatin and nab-paclitaxel (Abraxane). A press release suggested that it met 1 of its primary endpoints of PFS. Those data were presented briefly at the 2017 ESMO Congress, where they looked at carboplatin and paclitaxel with atezolizumab and bevacizumab (Avastin) versus carboplatin, paclitaxel, and bevacizumab.