Adjuvant Immunotherapy research with curative intent - 1271667

Hi Amy,

pembrolizumab, brand name keytruda has been approved for 2nd line therapy. Many people are calling it by its brand name keytruda for the simple reason pronouncing pembrolizumab is pretty hard to get a handle on :)

It sounds as if the phase II trial with concurrent chemo/rads is targeted at curing the patient. If you do a search on grace for stage III treatment your find some people who are healthy enough are treated with a platinum doublet and radiation. It's a tough treatment but may be worth it if if a cure is the final outcome. Sometimes radiation is given first then chemo, it's less toxic but also may be less effective.

Your guess is right, the trial is to see what happens in a curative setting for keytruda. That's a typical path for cancer research to take. While the data shows people with non-squamous nsclc with a higher number of pd-l1 do better than those with a lower number, but all have shown efficacy.

On a personal note, my husband was diagnosed 6 years ago with stage III inoperable nsclc (2 subsequent mets upstaged him but never were able to get positive biopsy on mets so who knows maybe was always stage III.) He received concurrent chemo/rad that may have cured him because he remains NED 3 years post chemo and 6 years post chemo/rads. It's a hellava road but we're both glad for the outcome.

Keep us posted and don't hesitate to ask as you go.

Janine

P.S. I'm going to move your post to make a new thread because it holds it own weight. Let me know if we need to change to title.

Amy,

I'm glad we can be of help. As the sub title suggests "definitive therapy" it is focused on a cure.

One of the trials that hasn't been able to accrue enough people is one that pairs surgery against chemo/radiation for curative treatment. Most people will choose surgery over radiation given the choice (if the tumor is reachable, patient is healthy enough that sort of thing). So it's impossible to know how chemo/radiation stacks up to surgery.

Although this trial isn't set up to measure surgery over radiation it does give people like your dad the chance for curative treatment that otherwise might not be an option. I don't think his pd-l1 numbers really matter especially if he's already been accepted.

I look forward to finding what he chooses to do.

Janine

Amy,

The wording, definitive therapy is in the news brief here, "NEWS BRIEF FEBRUARY 3, 2015
Penn Medicine's New Immunotherapy Study Will Pit PD-1 Inhibitor Against Advanced Lung Cancer

For first time, researchers will investigate PD-1 after definitive therapy in group of lung cancer patients" http://www.uphs.upenn.edu/news/News_Releases/2015/02/bauml/

As long as a nsclc is contained in just one lung it can be curable; one type of curative treatment often available to stage III nsclc is radiation given at the same time (concurrent) as a platinum doublet chemo. It appears that the trial wants to test whether or not adding immunotherapy after chemo/rads will give this group of people a better chance of cure. All trials set some arbitrary measuring points, this trial has set 18 months to see if the cancer returns. That's most likely because if the cancer is going to return it will within 18 months.

Some info for thought: Radiation in this case is to kill all the cancer, however studies have shown that adding chemo definitely adds several percentage points to the overall chance of cure. It's not understood what's happening but it might be that there are a few rogue cancer cells that sometimes gets cleared with the chemo or maybe the chemo adds radio sensitivity to the tumor.

The researchers are hoping that adding more will do more.

Does this help answer your questions?

Janine

Please don't apologize for anything you've said while learning this crazy difficult subject in such a stressful time. Don't forget cancer is used as a figure of speech to explain most any impossible situation. As long as we can find our way to the understanding we're looking for. :)

Hi Amy,

Thank you for the update. The value of PD testing to predict response is not clear. As Dr. Solomon said in a recent GRACE video:

"I think what’s clear is that PD-L1 does enrich for a group of patients that are more likely to benefit. But I think what’s equally clear is that, if a patient is PD-L1 negative, there’s still a chance that they can benefit from treatment with a PD-1 or a PD-L1 inhibitor. So, this strategy of using PD-L1 to enrich for a group of patients who might want to, for example, use a PD-1 axis inhibitor for the first line, probably does make sense, but it probably doesn’t make sense to exclude a patient based on PD-L1 negativity..." - http://cancergrace.org/lung/2015/11/11/wclc_2015_order_pd-l1_testing_be…

Good luck and best wishes for a great response to the trial regimen.

JimC
Forum moderator