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Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University

Chief of Hematology/Oncology
Medical Director of Memorial Cancer Institute

Lung Cancer Video Library - Spanish Language: Video #26 Integrating Immune Checkpoint Inhibitors Into First-Line Therapy for Advanced NSCLC
Author
Luis Raez, MD FACP FCCP
 

Integrando los inhibidores de los puntos de control inmunológicos en la terapia de primera línea para el cancer pulmonar avanzado de células no pequeñas

¿Cuál es el futuro de la inmunoterapia? Sabemos que la inmunoterapia está aprobada para segunda línea y que probablemente es nuestro fármaco favorito de segunda línea. Pero obviamente, todos queremos ver ese beneficio en primera línea, pero en primera línea tenemos evidencia sólida que la quimioterapia con bevacizumab para carcinomas o que la terapia con necitimumab para carcinomas de células epidermoide o escamosas, están bien establecidas.

Entonces las opciones que tenemos hoy en día, en base a los estudios con los 7 agentes inmunoterapeuticos disponibles para tratar de ver si lo mejor vas a ser reemplazar a la quimioterapia en primera línea, o si lo mejor va a ser añadir la inmunoterapia en primera línea. Esas dos opciones se están explorando para ver en cuál de los casos se van a hacer. A veces, la solución para poner quimioterapia en primera línea, es escoger que pacientes van a responder a la inmunoterapia y a ellos darles inmunoterapia de primera línea como hacemos con las terapia blanco en donde como vimos seleccionamos quienes son EGFR o ALK y a esos les damos la terapia blanco y al resto les damos la quimioterapia.

Esa es la solución, separar a los pacientes que van a responder de los que no y de esa forma ver a quien le damos inmunoterapia y quien le damos quimioterapia.

El único problema que tenemos, como ustedes saben, es que el marcador PDL1 no es un todavía un marcador estándar por lo que no hay todavía consenso de que sea la mejor forma para discriminar a quien se le da inmunoterapia y a quien no, por esa razón todavía hay mucho por hacer.


Integrating the immunological checkpoint inhibitors in the first line therapy for non-small cell lung cancer in advanced stage

What is the future of immunotherapy? We know that immunotherapy is approved for second line treatments and that it is probably our favorite drug in second line. But obviously, we all want to see this benefit in first line. However, in first line we have solid evidence that chemotherapy with bevacizumab or necitimumab for epidermoid carcinomas are well stablished.

Then the options we have, based on the 7 immunotherapeutic agents available, is to decide if it’s better to substitute chemotherapy in first line or to add immunotherapy to first line. In this two options, several cases are being studied to see which one works best. Sometimes the solution for first line chemotherapy is choosing what patients are going to respond to immunotherapy and give them first line immunotherapy as we do in targeted treatments with EGFR or ALK positive patients and the rest we give them chemotherapy.

That is the solution, separating the patients that are going to respond from the ones that are not and see who we can give immunotherapy and the ones we have to give chemotherapy.

The only problem we have, is as you know, PDL1 marker is not and standardized marker yet so we don’t have a consensus that it is the best way to discriminate who gets immunotherapy and who doesn’t. For that reason, we still have a lot to do.

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