GRACE :: Lung Cancer

Second line

Denise Brock

Lung Cancer Video Library – PDL1 as a Biomarker for Second Line



GRACE Cancer Video Library - Lung


H. Jack West, MD
President & CEO, GRACE


We are pleased to have GRACE’s Jack West, MD, Medical Director, Thoracic Oncology Program, Swedish Cancer Institute in Seattle, Washington, and President and CEO of GRACE bring 2017 updates to our Lung Cancer Video Library.  

In this latest video, Dr. West discusses exciting new advances in NSCLC –  PDL1 as a Biomarker for Second Line.







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Dr West

Immunotherapy Opdivo (Nivolumab) Non-Squamous NSCLC Trial Stopped, Reported as Positive


In January, 2015, the CheckMate 017 trial of the immune checkpoint inhibitor Opdivo (nivolumab) versus the standard chemo agent Taxotere (docetaxel) as second line therapy for patients with advanced squamous NSCLC was reported in a press release to be positive for a significant improvement in overall survival. No further details were offered at that time, but additional data were submitted to the FDA just days before the FDA approved Opdivo on March 4, 2015 and made it commercially available for these patients (with the FDA deserving credit for seemingly waiting in a conference room to go through an immediate approval process once the full data was supplied). We have since learned that Opdivo was associated with a significant, 3.2 month improvement in median overall survival, 9.2 vs. 6.0 months, but additional data await presentation at the annual ASCO meeting in Chicago in late May/early June.

Bristol-Myers-Squibb  (BMS) ran a parallel trial called CheckMate 057, also directly comparing Opdivo to docetaxel as second line therapy for patients with non-squamous NSCLC, which comprises about 75-80% of NSCLC patients in North America.  That trial completed enrollment around the same time as the squamous trial, but no results were forthcoming until this week, when a press release from BMS noted that an interim data review from this trial has demonstrated a significant survival benefit again for Opdivo — with no additional data offered yet. 

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Dr West

Why Don’t We Routinely Give Combination Chemo for Previously Treated Advanced NSCLC?


I just did a brief video that appears on my The Swedish hospital website/blog, addressing the question of why it is standard to give single agent but not doublet or other combinations to patients who have already received first line therapy for advanced NSCLC. As I cover in the video, the basic premise is that as treatment continues for patients on therapy for advanced NSCLC, it becomes only more and more important to balance the anticipated side effects of treatments against the incremental benefit of a more aggressive treatment.  Overall, most patients with metastatic/advanced NSCLC can tolerate and benefit meaningfully from  a combination approach for initial therapy (though a targeted therapy will be preferred for the vast majority of patients with a “driver mutation” such as an EGFR mutation or ALK rearrangement).  But beyond that point, as patients are experiencing cumulative effects from both the treatment and often the underlying cancer, the evidence reveals that combinations confer greater side effects but no accompanying significant improvement in overall survival.  

Instead, the prevailing standard of care, with the evidence to support it, is a strategy sequential single agent treatments, which may lead to further tumor shrinkage in some patients and prolonged stable disease in many others; these results often lead to an improvement in survival with a manageable balance of often modest side effects. Continue reading

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