We are pleased to have Nathan Pennell, MD, PhD, Director of Lung Cancer Medical Oncology at the Cleveland Clinic Taussig Cancer Center in Cleveland Ohio share with us updates for our Lung Cancer Video Library. Â
In this latest video, Dr. Pennell discusses the role for immunotherapy in patients with a driver mutation. Â
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Please feel free to offer comments and raise questions in our Discussion Forums.
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We welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University with 2017 updates to our Lung Cancer Video Library. Â In this recent video for GRACE, Dr. Raez discusses the Role for Immunotherapy for Patients with Driver Mutations.
Please feel free to offer comments and raise questions in our Discussion Forums.
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Drs. Leora Horn, Ben Solomon, & Jack West assess whether clinical factors such as being a never-smoker or having a driver mutation (EGFR, ALK, etc.) reliably predict minimal benefit from immunotherapy agents.
Podcast: Play in new window | Download (Duration: 2:54 — 35.0MB)
Please feel free to offer comments and raise questions in our Discussion Forums.
Transcript
Dr. West: We’re starting to see some early results suggesting that never-smokers and patient with driver mutations, like EGFR, or an ALK rearrangement, or ROS1, are particularly unlikely to have very good responses to these agents, the immune checkpoint inhibitors. Even if PD-L1 testing isn’t required, do these clinical characteristics matter to you, in terms of whether you’re less likely to recommend an immune checkpoint inhibitor as an early therapy in patients with no smoking history, or a driver mutation, are you thinking that this is really not likely to work, or are patients or clinicians so eager to use them that it’s really the first opportunity, no matter what the patient characteristics are?
Dr. Solomon: Yes, so I think the data so far haven’t been that exciting in patients, certainly with EGFR mutations, and probably also patients with ALK rearrangements, and why that is, I think, remains to be sorted out. Like you were suggesting, maybe it has to do with the mutational load, within tumors. So, I think — we want patients to receive the most effective treatments early on, and certainly, I don’t think there’s a role outside of clinical trial of using these inhibitors before therapy with an ALK or an EGFR inhibitor. I think there are some really interesting studies that look at using concurrent EGFR or ALK inhibitors with a PD-1 inhibitor, and I think it will be really interesting to see whether that increases response rates in these populations.
Dr. West:Â What are your thoughts about the role for immune checkpoint inhibitors in never-smokers, and patients with driver mutations?
Dr. Horn: I completely agree with what Ben said, you know, and many of those patients have been excluded from the first line trials, if you’re EGFR or ALK positive, because there are such great options for those patients. There was a little hint of — maybe we’re going to see some responses with the community study that was presented with nivolumab, where they showed around a 10-11% response rate in those patient populations — very small numbers, so maybe there are a group of patients that will respond, but I agree that the combination therapies look really, really interesting. The difference is that EGFR inhibitors — they’re incredibly effective, but at some point, they’re failing the patients, whereas, if a PD or PD-L1 inhibitor is working, they really have these long, durable responses that are often measured beyond just one year of therapy.
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