New treatment avenues in squamous cell carcinoma

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Published: 26 Jul 2017
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Dr Luis Raez - Memorial Cancer Institute, Hollywood (FL), USA

Dr Raez speaks with ecancer at NOSCM 2017 about treatment options for squamous cell carcinoma (SCC).

He discusses immunotherapies are providing an alternative to chemotherapy, noting the approvals for nivolumab and pembrolizumab in second and first line cases, and highlights the OAK study of atezolizumab as showing a clear benefit for SCC patients.

Dr Raez also considers investigational targets, including PI3K and FGFR, and describes the design of the Lung MAP trial, taking place in clinics across America.

Dr Raez also spoke with ecancer about lung cancer advances at the Best of ASCO 2017 meeting in Miami.

We are here in this very important meeting and we are going to talk about squamous cell carcinoma of the lung. That’s a very important topic and basically there are a lot of developments in squamous cell carcinoma of the lung. As we know, for example, we have two or three only chemotherapeutic agents available for this with a specific indication. That’s the case of gemcitabine that for years has been the preferred choice for squamous cell carcinoma of the lung. We also have nab-paclitaxel also approved for squamous cell carcinoma of the lung because nab-paclitaxel had a very important study presented years ago by Dr Socinski that all of us remember that showed a superior response rate compared with conventional paclitaxel.

But the interesting thing is apart from these drugs, because there are not too many new drugs for squamous cell carcinoma, we can use now immunotherapy. Nivolumab was originally approved with CHECKMATE-017 for squamous cell carcinoma patients for second line therapy so we are presenting again that data today. Then pembrolizumab came approved first line, new patients, as long as they stain more than 50% positive for the marker PD-L1. That is also another potential option for squamous cell carcinoma patients. Finally atezolizumab, the latest immunotherapy agent approved for lung cancer. In the original study, OAK is a phase III randomised study that got the approval for this drug in second line, there is a cohort of patients that were squamous cell carcinoma and they showed a clear benefit for this population. So that is why in summary we have now three immunotherapeutic agents that can be used on top of chemotherapy for squamous cell carcinoma of the lung.

What is new, squamous cell carcinoma has a lot of targets and despite the fact that we had too many targets we have been unable to find the right target and treatment for these targets. That is why, for example, we have a lot of studies with PI3CKA . PI3CKA is a genetic aberration that is popular also in breast cancer. We have tried already several inhibitors of this genetic aberration and it has been unsuccessful. We also have PTEN, we also have DR2 and a lot of very weird names, I don’t want to make a long list. Then we also have FGFR. For all of these genes that are peculiar in the molecular profile of squamous cell carcinoma we have a lot of clinical trials. Probably the most interesting clinical trial is Lung-MAP, it’s being done in the United States as a second line; there are more than one thousand hospitals that have this trial open. In this Lung-MAP we test three of these new inhibitors for these genetic aberrations, trying to see if we can make a difference in squamous cell carcinoma patients. For the patients that don’t test positive for any of these genetic aberrations we have immunotherapy as an alternative in the study.

Also in the conference today I’m presenting a long list of studies that are being run for squamous cell carcinoma. So it’s all very exciting because finally for squamous cell carcinoma we are getting new treatments that are going to benefit this large population of patients. We remember there are around 30% of all lung cancers in the United States, it’s easily 60,000 people that have this histology for lung cancer.

Regarding side effects of therapy, for example for squamous cell carcinoma, the benefit to having immunotherapy now available for squamous cell carcinoma, and hopefully this targeted therapy soon, is that even if we achieve the same response rate as chemo, that is not the case because immunotherapy has proved to be better, the toxicity profile of immunotherapy is much better than even chemo. So we’re very lucky that we’re not only improving their survival with immunotherapy for squamous cell carcinoma, we are also giving a much better toxicity profile. For example, patients don’t have to have leukopenia, they don’t have to have thrombocytopenia, they don’t have to come in for a blood draw every week or two. A lot of these immunotherapeutic agents you can give them every three weeks and the patient doesn’t have to come at all because the amount of side effects is minimal compared with conventional chemotherapy.