WCLC 2019 – Expert Commentary – Bringing immunotherapy in the clinical setting: a challenging opportunity

  • Cristina Ferrario — Agenzia Zoe
  • Univadis
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Jamie E. Chaft is a board-certified medical oncologist specialised in caring for patients with lung cancer. She is affiliated with the Memorial Sloan-Kettering Cancer Center, New York City, USA. Her research activity focuses on the use of multimodality therapies and biomarkers identification.

  • Immunotherapy (IO) has a pivotal role in the treatment of patients with advanced lung cancer as well as in the unresectable disease.
  • For example, in stage IV disease, IO is the standard of care in the front-line treatment of patients with tumours that highly express PD-L1 and do not have a contraindication to the therapy.
  • Moreover, in patients with stage III non-small cell lung cancer (NSCLC) who do not progress through concurrent chemoradiotherapy, consolidation IO improves progression-free and overall survival. 
  • For patients with resectable lung cancers, there is not yet a proven role for the IO although there is an exceptional amount of interest on the topic.
  • In particular, the role of adjuvant IO after standard of care chemotherapy is under investigation in 4 phase 3 clinical trials that will certainly give us insights into whether one or more available IO agents are effective in the postoperative setting.
  • The big challenge we face is that adjuvant studies require many years of clinical follow-up, while our patients need studies that result before design or drug is outdated. Rethinking trial design may help achieve this goal.
  • The use of IO in the neoadjuvant setting is now emerging as a new opportunity for lung cancer patients.
  • In preclinical models, PD-1 monotherapy was shown to be more effective when administered in neoadjuvant versus adjuvant settings and some previous studies have spurred a great interest in the best neoadjuvant therapy. Four international studies are now recruiting patients to study neoadjuvant chemotherapy with or without IO.
  • Evaluating the pathological specimens very systematically and analysing them in a way that allows us to make determinations about therapy efficacy could help improve these IO strategies.
  • Molecular testing could be a problem in terms of time and money, but the scenario is now improving from different points of view. I think that within the next years we will be able to identify driver mutations in a reasonable timeframe to prescribe an adjuvant or neoadjuvant therapy.
  • New studies on chemo-immunotherapy will give us the possibility to help more people around the world but we still need to understand who needs these drugs. Not everyone needs everything, and we don’t know who needs what at the moment.