What's New and What's Next in Lung Cancer

The past decade — and the last few years in particular – have brought landmark advances in the field of lung cancer. Immunotherapy agents such as nivolumab (Opdivo), ipilimumab (Yervoy), and atezolizumab (Tecentriq) have drastically improved outcomes for patients with the disease, as have targeted agents and TKIs.

“It’s really been an exciting 5 years in lung cancer,” said Kaushal Parikh, MD, MBBS, in an interview with OncLive, a sister publication of Oncology Nursing News.

Parikh, a medical oncologist in the Division of Thoracic Oncology and Early Therapeutics at Hackensack University Medical Center, explained that 2 trials (CheckMate-227 and IMpower110) were especially exciting in the year 2019.

CheckMate-227

CheckMate-227 was a large, randomized trial including 1,700 patients. Part 1a of the trial randomized participants in a 1:1:1 ratio to receive nivolumab plus ipilimumab, chemotherapy, or nivolumab alone.

Study results showed a positive overall survival (OS) trend for patients assigned to the combination, compared to the chemotherapy arm (17.1 versus 14.9 months, respectively) in the PD-L1—positive patients.

“This combination gives us another option for our patients in the frontline setting. We do need to be aware of the toxicity profiles of these 2 drugs given concurrently for a patient with a high PD-L1 status,” Parikh said. “We have been using pembrolizumab (Keytruda) for a few years now, and it does appear to be a safe option. However, in several patients, nivolumab/ipilimumab is an option.”

IMpower110

IMpower110 was another large, randomized trial. This one compared atezolizumab with chemotherapy in PD-L1—positive patients, as determined by atezolizumab’s companion diagnostic, VENTANA PD-L1 (SP142), which categorizes PD-L1 status as 1+, 2+, or 3+.

For patients whose tumors had 3+ PD-L1 expression, there was about a 20-month OS, compared to 13 months with platinum-doublet chemotherapy.

“The only statistically positive finding we saw was in the 3+ population. We saw meaningful numbers for the remainder of patients, but it was not statistically significant,” Parikh said.

2020 and Beyond

More exciting advances await in the lung cancer field, according to Parikh, who mentioned that immunotherapy agents are now being moved into the frontline space after being tested in the advanced, then second-line setting. This is what happened with durvalumab (Imfinzi), which has “broken the frontline barrier,” according to Parikh, and is now approved for patients with stage III non-small cell lung cancer following concurrent chemoradiation.

“There are other trials looking at immunotherapies, as well as targeted therapies, in the adjuvant and neoadjuvant settings, and after chemoradiation. Osimertinib (Tagrisso) is being looking at in stage III EGFR-mutated NSCLC after concurrent chemoradiation,” Parikh said.

“The ALCHEMIST [trial is seeking] biomarkers for specific treatments in the adjuvant setting. I am excited about these and hopefully they will show good news for our patients.”

A version of this article originally appeared on OncLive as, “Expert Reflects on Recent Advances in Lung Cancer.”