This ESMO meeting is really interesting in terms of data that has been presented because we have new information very useful for patient management in clinical practice and also we have updates on other trials that have been already presented. Probably among the new data that we have in lung cancer, one of the most relevant trials is the IMpower130. This is a phase III randomised trial comparing in patients with non-small cell lung cancer and non-squamous histology in a metastatic stage the combination of nab-paclitaxel and carboplatin versus the same regimen together with atezolizumab. Atezolizumab is a monoclonal antibody against PD-L1 that now is approved in the second line setting and also this drug in combination with other chemotherapy regimens already demonstrated to improve survival of patients.
In the IMpower130 trial more than 700 patients were randomised and the trial met the primary endpoints of progression free survival and overall survival because in this study we had a significant prolongation of progression free survival and a significant prolongation of overall survival for patients that were assigned to the atezolizumab treatment. In terms also of toxicity profile no unexpected toxicity was observed in the study and therefore the conclusion is that this combination is one of the new additional options that we have with chemoimmunotherapy in patients with metastatic non-small cell lung cancer.
The IMpower130, what was important also was the subgroup analysis because the benefit observed with a combination with chemoimmunotherapy was present in all subgroups, irrespective also of PD-L1 expression. We also had some interesting data for patients with liver metastases or patients with EGFR or ALK rearrangement because in the IMpower130 no benefit was observed in patients, no difference was observed in terms of progression free survival or overall survival in patients with liver metastases. Also no difference in PFS and OS was observed in patients with EGFR mutations or ALK rearrangements. This data probably confirms that we need additional strategies and one of the most promising, specifically in patients with liver metastases or EGFR mutations and ALK rearrangements, is probably the combination with anti-angiogenic agents such as bevacizumab.
It’s interesting that you draw the attention to the second line use of immunotherapy there. Are there any other agents, any other platforms which could take that space instead of immunotherapy?
In second line small cell lung cancer unfortunately we have very few agents really working. We have some data that support the potentiality of agents such as rovalpituzumab or lurbinectedin but at the present time we don’t have any evidence that allows us to consider these agents as the new standard. So at the present time unfortunately chemotherapy remains the standard therapy in patients with small cell lung cancer.
