Immunotherapy in Lung Cancer: Current Landscape and Future Directions

PD-1/PD-L1 inhibitors are standard of care in advanced and metastatic non-small cell lung cancer (NSCLC), and several studies reported at the American Society of Clinical Oncology (ASCO) annual meeting have shown a significant benefit with these checkpoint inhibitors administered either before or after resection in early-stage NSCLC.

In this exclusive MedPage Today video, Jorge Nieva, MD, from the Keck School of Medicine at the University of Southern California in Los Angeles, discusses the current options available and what the future holds for immunotherapy in lung cancer.

Following is a transcript of his remarks:

Well, we had a great session for adjuvant therapy of lung cancer. We have now many drugs that are options for patients with early-stage disease to use to improve survival. We had presentations from the KEYNOTE-671 trial. We had presentations from Neotorch. And the great news for patients is that there’s now lots of options.

You could give a CheckMate-816-type regimen using nivolumab [Opdivo] in the neoadjuvant setting. We know that we have prior data with atezolizumab [Tecentriq] from IMpower studies, and now we have KEYNOTE-671 showing that pembrolizumab [Keytruda] has benefits for patients in terms of progression-free survival for patients who are treated in the perioperative setting. So both neoadjuvant and adjuvant.

You can put that now on top of the AEGEAN trial showing benefit to the adjuvant use of durvalumab [Imfinzi]. And then we also had data from the Neotorch trial using toripalimab, which is not yet approved in the United States, but may be coming soon also. So we really have many different options, and these drugs are all very active in this setting.

I think it’s a really hard question to decide which approach to use, and I think it’s going to have to be individualized. Obviously, surgeons decide who gets neoadjuvant therapy and who doesn’t by deciding who they refer and who they don’t refer. So for the patients who are referred for neoadjuvant therapy, we now have options of nivolumab or pembrolizumab, and either one of those would be appropriate. But the surgeons aren’t going to send everybody to you for neoadjuvant therapy, and you’re going to have to give some patients treatment after surgery who didn’t get neoadjuvant therapy.

And for those patients, atezolizumab is an option with an overall survival benefit, particularly in the PD-L1 over 50% group. And then pembrolizumab typically would be used before and after. But we also have the option of durvalumab to be used afterwards.

There’s going to be more immunotherapy trials coming, and we’re going to see results of the SKYSCRAPER trial with TIGIT added on. And there’s going to be other companies adding other agents that are immune checkpoint inhibitors to try to optimize adjuvant therapy for these patients.

But right now it looks like PD-L1 monotherapy is the treatment of choice for today. But I think next year and maybe the year after that, we’ll start looking at dual checkpoint inhibition in the adjuvant setting and hopefully further improve the outcomes for our patients.