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.  In this recent video for GRACE, Dr. Raez discusses First Line Immunotherapy for Advanced Non-Small Cell Lung Cancer NSCLC.

 Dr. Luis Raez, MD FACP FCCP

These are very exciting times because we have recently moved immunotherapy to first line, meaning new patients with stage IV non-small cell lung cancer or metastatic patients.   Until recently immunotherapy was approved first for second line and based on some studies - very important - but immunotherapy, after that moved to the front line, so that new patients can have an opportunity to be treated.  Specifically, the Pembrolizumab was moved to the front line based on a study in which the Pembrolizumab was compared against chemotherapy, Carboplatin combination that are the standard of care so far and Pembrolizumab was able to give better outcomes than the combination or amalgamation of chemotherapy but the most important thing in this news is that we are developing markers to try to discover which patients will respond to immunotherapy and which ones will not.  The specific marker that probably everyone knows or cares about is PD-L1.  In this specific study, the patients will benefit from immunotherapy for new patients if the PD-L1 expression in the tumor, we are checking in the tumor, is more than 50%.  Immunotherapy front line was not approved for everybody, it was approved for this specific niche of patient that they will benefit.  The rest of the patients will still need to get chemotherapy or target therapy based on molecular markers if they have any of these genetic alterations that we reference all the time, EGFR, ALK, ROS1.  We only had one drug approved because unfortunately the other drug, Nivolumab, is already approved for second line.  In a similar study, Nivolumab was much against chemotherapy and Nivolumab was unable to get a better progression free survival than the patients on chemotherapy.  For that reason, we only have as a single agent so far, Pembrolizumab, approved in first line.  Of course, there will be changes because we have other immunotherapy agents coming to the market soon and new studies coming soon but so far Pembrolizumab is only approved as a single agent in the front line.