Developments in neoadjuvant immunotherapy options for early-stage lung cancer patients

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Published: 11 Jun 2019
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Dr Luis Raez - Memorial Healthcare System, Hollywood, USA

Dr Luis Raez speaks to ecancer at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting about exciting developments in lung cancer treatments from this year's meeting.

Dr Raez also provides his insight into the exciting developments in lung cancer treatment featured in this year's meeting, including the update on the LCMC study which uses atezolizumab both in the neoadjuvant and adjuvant setting.

Dr Raez also speaks about the results from the NEOSTAR trial, which combined immunotherapeutic agents nivolumab and ipilimumab in the neoadjuvant setting.

Dr Raez said the development of neoadjuvant options for early-stage lung cancer patients, as well as trials combining immunotherapy with chemotherapy, provides a very promising landscape for the future of lung cancer treatments.

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I want to talk first about the high-risk in lung cancer in ASCO; I think this is a very exciting year. As many of the people in the audience know, for patients with early stage lung cancer, stage 1, 2 and 3, the standard of care has been for many, many years start with surgery followed sometimes by chemotherapy and occasionally radiation therapy. But now that we have immunotherapy arriving and already conquering higher stages, like stage 3 or 4, it has been very exciting for us to have two presentations yesterday regarding immunotherapy, neoadjuvant, meaning immunotherapy before surgery. The first presentation is from New York, from Dr Valerie Rusch’s group. The study is called LCMC that was originally partially presented last ASCO and then there was another update in World Lung. We were very excited to see an update here. Basically patients received two cycles of atezolizumab before surgery followed by surgery and more atezolizumab as adjuvant treatment. The success has been that this neo-immunotherapy can cause a major pathologic response. A major pathologic response is defined when there is less than 10% of the tumour present in the specimen at the time of surgery. So this intervention with only two cycles of immunotherapy has been able to cause a major pathologic response in more than 30% of the patients. So this is something very promissory, very exciting for us, that can influence the standard of care.

The second study is very similar, the NEOSTAR study from MD Anderson. The original thing in the study was they did not only give one agent, in this case nivolumab, but also they combined with another immunotherapeutic agent, ipilimumab. So giving nivolumab for three weeks with ipilimumab before surgery the researchers were able to show that there is also major pathologic response in close to 40% of the patients.

So all of these things are new, as I said, and are very exciting and they may help to change the standard of care soon, meaning instead of going straight for surgery patients with early stage can have neoadjuvant immunotherapy first. This adds to the evidence that we already have from the last World Lung Cancer Congress where, again, there were two important presentations, this time not only immunotherapy alone but chemo plus immunotherapy as neoadjuvant intervention that were positive, that is showing amazing major pathological response of more than 50%. So that is why little by little we are building a nice story and little by little we are going to be able to offer these patients before surgery immunotherapy. With the evidence that they presented in this ASCO maybe immunotherapy as a single agent or an immunotherapy combo. With the evidence that we have from World Lung, from the NADIM study from Spain and others, we will see if maybe the combination with immunotherapy and chemotherapy are a better approach. But in any case, as I said, the standard of care is going to change soon and all of these interventions or giving immunotherapy or the combo chemo-immunotherapy before surgery do not affect the outcome of the surgeries, do not delay the surgeries and they are non-toxic for the patients. The patients benefit tremendously of these interventions.