Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 17Case discussion: A 53-year-old woman with recurrent KRAS mutation-positive adenocarcinoma of the lung and brain metastases receives an immune checkpoint inhibitor
2:30 minutes.
TRANSCRIPTION:
DR BLUMENSCHEIN: So about 3 years ago, she presented with symptoms secondary to brain metastasis, and she was found to have an adenocarcinoma that’s KRAS mutation-positive. And her brain metastasis was treated with stereotactic radiosurgery. And then she received chemotherapy with carboplatin/pemetrexed and then docetaxel. And eventually, she enrolled on a clinical trial with a PD-L1 monoclonal antibody and took roughly 19 cycles of treatment. So she was on that for a good long while. Had a great response. It was a durable response. DR LOVE: So she actually had an objective response? DR BLUMENSCHEIN: Yes. She had a RECIST criteria response. DR LOVE: Wow! DR BLUMENSCHEIN: She had a good response. DR LOVE: Where was the disease? How long did it take the response to occur? DR BLUMENSCHEIN: She had disease in her lung and in her liver. And it took roughly, I think within the first 2 cycles of treatment, she was beginning to respond. And I’ve noticed with this class of agents that patients, if they’re going to respond, tend to respond within the first scan. DR LOVE: Any tolerability issues with her? DR BLUMENSCHEIN: No, she didn’t. We’ve had some patients who’ve developed colitis. In rare cases, pneumonitis, even thyroiditis. But she didn’t have any issues vis-à-vis that. She did well for 19 cycles. And then I think the interesting part is, after she progressed, she got additional chemotherapy. And then we sat down and talked about options, and we went ahead and rechallenged her with nivolumab. And she’s now in her 15th cycle, I think, of nivolumab. DR LOVE: And that’s what really struck me about this case. The re-treatment, did she have an objective response? DR BLUMENSCHEIN: She didn’t have a PR, but she definitely had decrease in her disease burden. And, more importantly, from my standpoint, is her disease remains stable after presenting with additional progression. And that speaks to we’re not really clear how to utilize these drugs: What’s the duration of treatment? Do you get T-cell fatigue from continuous exposure? Those things are all being investigated in a subsequent series of studies, like what’s the duration of therapy? Do you need treatment breaks and then rechallenge? And this is just an empiric case of someone who got additional treatment after progressing on a checkpoint inhibitor and has now benefitted from additional checkpoint exposure. |