PD-L1 antibodies, such as atezolizumab (Tecentriq) and durvalumab (Imfinzi), might have different molecular characteristics in terms of how they act and function. It is an attractive idea to use those agents when first-line immunotherapy does not work.
What is the current state of liquid biopsies?
There are scenarios in which decision making is complicated by inadequate tissue samples present for molecular testing. The science of liquid biopsy is evolving and improving so rapidly, especially in regard to detection of circulating tumor DNA and targetable mutations, such that in the future, the timing of salvage therapy and the selection of that therapy may be accomplished without the risk of repeat biopsy.
In the case of EGFR mutations and specifically T790M mutations, literature suggests that liquid biopsy may replace the need for solid tissue acquisition. As the technology improves, we will see decreased need for repeat biopsies when the appropriate answers and choices can be gleaned serologically.
What advice can you provide for community oncologists in approaching combinations for their patients?
As with any patient with NSCLC, one wants to ensure that the patient has adequate performance status to be challenged with aggressive treatment, and that the tissue or serum analysis supports the frontline choice. It also remains important to enroll patients in trials of combinations for this disease, as the many remaining questions will likely only be answered by such results in the future.
Is there anything else you would like to add?
At the Levine Cancer Institute, we are dedicated to providing therapy for patients with NSCLC as well as other cancer types. Within the next calendar year, we will be opening a neoadjuvant study of a PD-L1 antibody to be provided in potentially resectable patients which, given their stated efficacy in advanced disease, improving the opportunity for cure in early stage disease is critical.
Papadimitrakopoulou V, Gadgeel SM, Borghaei H, et al. First-line carboplatin and pemetrexed (CP) with or without pembrolizumab (pembro) for advanced nonsquamous NSCLC: updated results of KEYNOTE-021 cohort G. J Clin Oncol. 2017;35(15 suppl; abstr 9094). doi: 10.1200/JCO.2017.35.15_suppl.9094.