Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 15Immune checkpoint inhibitors as second-line therapy for NSCLC
2:58 minutes.
TRANSCRIPTION:
DR LOVE: Obviously nowadays with checkpoint inhibitors pretty much, I think, standard second-line therapy after chemotherapy, one of the questions in my mind is, what’s second line? And, specifically, what about the patient who gets chemoradiation for locally advanced with early relapse — let’s say before a year? Or even the patient who gets adjuvant therapy and early relapse again, 6 months to a year, how would you visualize these patients in terms — I don't know what the regulatory/reimbursement issue is, but from a clinical point of view, should these kinds of patients be getting checkpoint inhibitors or first-line chemo? DR MOK: Right. So that is a blurred area, is that would you consider the management of Stage III to be first line and whatever after to be second line, if it comes back early enough? So I think it’s a matter of definition. But, then, going back to the biology, if you do actually give systemic chemotherapy, just like what I did for this patient, and then patient recurs within 6 months, you know that it is unlikely for the patient to be chemosensitive. DR LOVE: And that’s a clinical occurrence. DR MOK: Exactly. So I won’t have a blanket statement about this kind of situation, but I really will look at individual patient. And did he really have a good response to chemotherapy? And then, how quickly it recurs? And then, if I got a sense that the patient’s unlikely going to have a benefit from further chemotherapy – because the pemetrexed/platinum is probably one of the better combinations that we have. If they are resistant to that, then putting on another taxane-based chemotherapy is unlikely to benefit the patient as much. So, those are the patients I may discuss about the use of immunotherapy. DR LOVE: I am curious about how you approach the issue of selection of checkpoint inhibitors and use of PD-L1 assays. I don't know what kind of regulatory constraints you’re under. You know what’s going on in the US, but what’s going on with you guys? DR MOK: So I actually did write editorial for the KEYNOTE-010 study. And I actually state my point quite clearly, is, I don’t believe the biomarker is doing a good job in selection. Right now, the overall response rate is 20%. The patient with high expression may have a slightly higher response rate. And then the patients who are negative may have a lower response rate, but it doesn’t mean that they don’t respond. So, in a way, even for the patient with negative, totally negative one, their efficacy will be equal to docetaxel but not worse than docetaxel. So what are we selecting? I mean, in a way is that we’re just selecting patients high versus lower, but not yes versus no. And for patients in a second-line setting, what other option do they have, if they don’t have a molecular target? So, in a sense, is that the patient we’re eventually going to use it, whether you put it second line or third line. So why select it? |