Today I have moderated a session in early stage non-metastatic non-small cell lung cancer and other thoracic tumours. We had four very nice presentations, the first presentation was a randomised trial comparing in patients with a stage 3 and EGFR mutations erlotinib versus chemotherapy. The study showed a high response rate for erlotinib and longer progression free survival. However, I have to say that it’s really difficult to do this kind of studies in this group of patients with EGFR mutations so no clear conclusions to change the standard of care after this presentation.
We had a second presentation comparing in the neoadjuvant setting nivolumab versus nivolumab plus ipilimumab. Again, preliminary results but a very interesting translational research analysis from the study. There was a presentation in small cell lung cancer, second line, comparing atezolizumab versus chemotherapy. It’s randomised but the study is not powered to compare directly but it’s true that atezolizumab as monotherapy achieved only a 4% response rate so probably we need other strategies in non-small cell lung cancer such as the combination with chemotherapy or other agents.
Probably the study that will change our standard is that we had the data results from the PACIFIC. PACIFIC is a study in patients with stage 3 treated with chemo and radiotherapy without progression. Patients were randomised to durvalumab or placebo and the study showed longer overall survival with maintenance durvalumab when compared to placebo.
In terms of the lung cancer space as a whole, how do you see the wave of new agents, immunotherapies, combinations, changing people’s practice but also changing outcomes for patients in their lives and livelihoods?
I think in the last ten years there has been amazing improvement, new studies, positive studies, new strategies in lung cancer. So if we remember in 2004 the EGFR mutations were detected and now we have two very interesting lines of research of reality, that is precision medicine – we know that lung cancer is not only one disease, we have EGFR, ALK, ROS, BRAF, these are a selected group of patients that should be treated in a different way – but also immunotherapy. So we had immunotherapy as a standard second line but now we have a number of studies showing that also immunotherapy has a role in the first line setting.
Newer studies are showing us that probably immunotherapy may also have a role in patients with early stage disease. So amazing times and new treatment strategies for patients with lung cancer.