mBAC / AIS and immunotherapy nivolumab

Portal Forums Member Updates Lung Cancer Member Updates mBAC / AIS and immunotherapy nivolumab

This topic contains 3 replies, has 3 voices, and was last updated by  Dutch46 1 month, 1 week ago.

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March 9, 2017 at 12:09 pm  #1290307    


My wife is about to start her 4th line of treatment, the immunotherapy drug nivolumab. Anyone out there with NSCLC of the subtype mBAC (now known as AIS) undergoing treatment with nivolumab (OPDIVO)? Any feedback about efficacy of the drug, side effects, and so on will be helpful.

In 2014 she was in the TECENTRIQ (atezolizumba) trial but was assigned docetaxel. The expression level was apparently low. I read (PD-L1 Blueprint Project) that the assays (to determine expression levels for PD-L1) for nivolumab, pembrolizumab, and durvalumab, showed similar results whereas the assay used for atezolizumab consistently showed fewer tumor cells compared to the other three.


My wife, 70 yrs. DX Mar 11 NSCLC mBAC (now called AIS). Mar 11 lobectomy left LL & lower UL. Scans: May 11 clean; July 11 bilateral GGOs; Sep 11 more prominent GGOs; Dec 11 worsening GGOs; Feb 12 PET scan further growth, no mets, BRAF positive (V600E);Mar 12 started Carbo-Alimta (6 courses) then Alimta maintenance; initial shrinkage then stable till early 2014; June 14 in trial MPDL3280A (atezolizumab) but was assigned docetaxel stopped Oct 14 after 7 courses side effects too severe. On chemo pause. May 15 started Tafinlar-Mekinist. Initially high fever, chills and Grade 3 uveitis in both eyes. August 15 Tafinlar from 300 mg to 150 mg a day, kept Mekinist at 2 mg a day. Side effects now manageable. Scans early Aug 15 and late Oct 15 showed improved. Latest scan 2/29/16 was very good: GG densities have resolved, no discrete masses are seen: Aug 16 scan still good; Feb 17 scan new growth. Treatment discontinued. About to start immunotherapy drug nivolumab.

March 10, 2017 at 7:52 am  #1290312    
JimC Forum Moderator
JimC Forum Moderator

Hi Dutch46,

I hope someone who has used nivolumab in this context can chime in, because I don’t have an good data to share with you on its efficacy in mBAC, but Dr. Evan Lipson of Johns Hopkins presented some good information on managing immunotherapy side effects in this podcast.

I checked out the PD-L1 Blueprint Project assay comparison paper; thanks for pointing out that interesting study. It illuminates the issue of just how slippery the distinction between high and low PD-L1 expression can be, as well as the still-open question of how well does the level of expression predict response to treatment. Different trials use varying cutoffs between high and low, and as the report states, the experience of the pathologist with a particular assay can be a factor. It’s certainly doubtful that a patient just above the chosen threshold will fare significantly better than one just below it. Although it may not provide much comfort to you and your wife, who were hoping to get the trial drug, in almost two-thirds of the small number of cases there was agreement between all four assays, and by one practical standard, the assay chosen might only have affected inclusion in about 15% of the cases.

I hope that nivolumab proves especially effective for your wife, and that side effects are minimal and manageable. Please let us know how she is doing with the new therapy.

Forum moderator

Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then:

March 13, 2017 at 8:35 am  #1290346    
Dr West
Dr West

I don’t think there’s any significant experience yet for treatment mucinous BAC/adenocarcinoma with immunotherapy. I have had occasion to treat a few patients with mucinous BAC with immunotherapy over the past couple of years, and the results haven’t been particularly impressive. On the other hand, when you’re talking about just 3-4 patients, it’s too early to say that a new treatment approach won’t be helpful. Other than saying that it isn’t likely to be amazing for the majority of patients with mucinous BAC, I wouldn’t say that the results are necessarily any different for a broader range of NSCLC patients, where the response rate is about 20% overall, and more in the 5-10% range for those with low or no PD-L1 expression. But if it happens to be effective, it can work for a very long time, with few or sometimes even no side effects.

Good luck.

-Dr. West

March 14, 2017 at 11:19 am  #1290361    


Dr. West, thank you for your feedback.

We hope to eventually generate some helpful and hopefully encouraging feedback. This being her fourth line of treatment means our options were limited.
Reflecting the first line of Carbo-Alimta (which you at the time you favored as well) worked for more than two years. The second line was docetaxel, which did work but she had to stop after seven courses because of the devastating side effects. This was in the atezolizumab trial OAK but she was assigned the docetaxel arm. The third line as the dabrafenib-trametinib combo which was possible because she had the BRAF V600E mutation. This worked for over a year and a half well in excess of the 9 months median.
We are grateful that we have had the good fortune to have workable options over the last six years and gope to add OPDIVO to that list.

Will post our experiences as they occur.


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