What was your talk about?
Hi, my name is Luis Raez, I’m the Medical Director of Memorial Cancer Institute and Chief Scientific Officer. Today we’re going to talk about immunotherapy for lung cancer. The last two years have been very exciting because we are doing now neoadjuvant immunotherapy for lung cancer before surgery and also we are integrating the data from adjuvant immunotherapy. As we know, for example in the last ASCO, we have discussed several trials that are new. This year in AACR they presented a trial called AEGEAN that basically had both modalities. Until this year, with the data from last year and the year before, we were only debating which one is better, the neoadjuvant immunotherapy or the adjuvant immunotherapy, because we had two options that then in the United States had been approved. The neoadjuvant immunotherapy was approved with CheckMate-816, three cycles of chemotherapy with nivolumab, and the adjuvant immunotherapy was already approved by a study called IMpower010 with atezolizumab for one year after surgery.
So that’s why this year it was very interesting that now we have this AEGEAN study basically giving durvalumab with chemo before surgery and continuing the durvalumab as adjuvant one year after surgery. The outcomes, the endpoints, are statistically significant and they are positive for event free survival and complete pathological response, meaning that the tumour disappears. So that was the first study; that was presented in AACR and we discussed the study again in ASCO.
Then there is another study called KEYNOTE 671 that uses the agent pembrolizumab in the same fashion. They use neoadjuvant pembrolizumab with chemotherapy, we do the surgery, and then we do adjuvant pembrolizumab and it’s another study that all the outcomes and endpoints are positive. That’s why it’s very exciting for us, the fact that now we have data even for both, for neoadjuvant and adjuvant immunotherapy.
Finally, we have a Chinese study with a new drug called toripalimab. It’s another anti-PD-1 that is not approved yet in the United States but they already have data of neoadjuvant use, surgery and adjuvant use for a year that is also statistically significant and is positive. So it is three studies that show that we can use both modalities in our patients with lung cancer. We’re very excited about all the options.
Of course, the controversies are do we really need both – maybe neoadjuvant is enough, maybe adjuvant is enough, why do we need to do two? In principle all of us agree that neoadjuvant there is no discussion about that because you are treating a patient that has a tumour inside so 100% of the patients have tumours. The controversy comes with the adjuvant side – if you have patients, for example with a stage 1b, maybe more than half are already cured and giving adjuvant immunotherapy we don’t know if they are cured or not. Maybe not everybody needs it. That’s why there are a lot of sessions, like biomarker sessions today in the meeting, that we want to try to see which patients really are the ones that need therapy, which patients don’t. One potential way to do that is with ctDNA, in a way to try to find which patients have minimal residual disease. Maybe in the future these are the only patients that we need to treat, we don’t need to give immunotherapy or chemotherapy or even targeted therapy to everybody after surgery unless we can prove which patients are not cured yet. Hopefully the ctDNA and other molecular markers can do that.
Could you provide an overview of the comprehensive cancer care services available at Memorial Cancer Institute?
We are Memorial Cancer Institute Florida Atlantic University and we are one of the six Florida Cancer Centers of Excellence, designated by the government of Florida. We have 75 cancer centres in Florida. We do a lot of education – GME, graduate medical education; we have 15 haematology oncology fellows in training. That’s a lot, it’s one of the largest programs in the state. We do a lot of cancer research; we do a lot of phase I studies, phase II studies.
Today we have around 65 clinical trials open for our patients and we offer our patients agents and drugs that are available to them two or three years before FDA approval. That makes us very happy because the patients, especially patients that have fairly standard care, they have options to prolong their survival if we cannot cure them and have still a good quality of life.
So that’s our passion to do cancer research and move the needle looking for the cure for cancer.
Can you highlight any specialised programs or services offered by MCI that have been developed in collaboration with Moffitt Cancer Center?
We also have an amazing partnership with Moffitt, Lee Moffitt from Tampa. We have in Memorial Cancer Institute, here in south Florida, nine Moffitt doctors and 25 advanced practice providers from Moffitt that they live and work in our facilities in Memorial Hospital West. We gave Moffitt our bone marrow transplant unit, our cellular therapy unit and they are in charge of every haematology malignancy treatment in our facility. We are very happy to have them there – our patients are getting the best haematology malignancy care in the world because Moffitt is one of the best hospitals in the world for that. We think that with this partnership we are benefitting the people in south Florida because they have access to really first-class care in the world here at home.