Is Lung Cancer Immunotherapy Clinic-Ready?
Is Lung Cancer Immunotherapy Clinic-Ready?
Editor's Note:
Early findings on PD-1 and PD-L1 inhibitors have raised enticing questions about the role of immunotherapyin the management of non-small cell lung cancer (NSCLC). To focus on these issues, H. Jack West, MD, Medical Director of the Thoracic Oncology Program at the Swedish Cancer Institute in Seattle, Washington, recently spoke with Suresh S. Ramalingam, MD, Professor of Hematology and Medical Oncology at the Winship Cancer Institute of Emory University in Atlanta, Georgia, and Chair of Thoracic Malignancies Committee for the Eastern Cooperative Oncology Group. Together, they put emerging data into clinical perspective.
Dr. West:Immune checkpoint inhibitors specifically focusing on PD-1 and PD-L1 are clearly active in NSCLC. In your assessment, are they applicable to a broad population in the way we think of chemotherapy, or are they likely to emerge as primarily beneficial for a more selected population -- as we've come to think of targeted therapies, such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) inhibitors?
Dr. Ramalingam: The early data from studies of PD-1- and PD-L1-targeted agents have been exciting and encouraging, with single-agent response rates of 20% among all enrolled patients. In addition, many of the responding patients remain on therapy without progression for several months to even more than 1 year.
At this point, I think we're a little early in terms of biomarker discovery. PD-L1 expression seems to be a potential biomarker, but clearly more data are needed before we can conclude that the drug only works for this particular biomarker-positive patient population. For now, I think we have to study these agents in an unselected manner, with a focus on biomarker discovery until we narrow down and validate predictive biomarkers.
Which Patients Are Most Likely to Benefit?
Editor's Note:
Early findings on PD-1 and PD-L1 inhibitors have raised enticing questions about the role of immunotherapyin the management of non-small cell lung cancer (NSCLC). To focus on these issues, H. Jack West, MD, Medical Director of the Thoracic Oncology Program at the Swedish Cancer Institute in Seattle, Washington, recently spoke with Suresh S. Ramalingam, MD, Professor of Hematology and Medical Oncology at the Winship Cancer Institute of Emory University in Atlanta, Georgia, and Chair of Thoracic Malignancies Committee for the Eastern Cooperative Oncology Group. Together, they put emerging data into clinical perspective.
Dr. West:Immune checkpoint inhibitors specifically focusing on PD-1 and PD-L1 are clearly active in NSCLC. In your assessment, are they applicable to a broad population in the way we think of chemotherapy, or are they likely to emerge as primarily beneficial for a more selected population -- as we've come to think of targeted therapies, such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) inhibitors?
Dr. Ramalingam: The early data from studies of PD-1- and PD-L1-targeted agents have been exciting and encouraging, with single-agent response rates of 20% among all enrolled patients. In addition, many of the responding patients remain on therapy without progression for several months to even more than 1 year.
At this point, I think we're a little early in terms of biomarker discovery. PD-L1 expression seems to be a potential biomarker, but clearly more data are needed before we can conclude that the drug only works for this particular biomarker-positive patient population. For now, I think we have to study these agents in an unselected manner, with a focus on biomarker discovery until we narrow down and validate predictive biomarkers.
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