Comment: Nivolumab plus ipilimumab combination for advanced NSCLC

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Published: 28 Sep 2019
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Dr Marina Garassino - National Tumor Institute, Milan, Italy

Dr Marina Garassino comments on data from the CheckMate-227 trial during a press conference at the 2019 ESMO congress.

This was a trial looking at the two immunotherapy drug combination of nivolumab plus ipilimumab as treatment for a subset of patients with advanced non-small cell lung cancer (NSCLC) compared to chemotherapy.

Watch the press conference here.

Watch Dr Marina Garassino's interview with ecancer here

Read more about the study here.

Good morning everybody. So it’s incredible that after five years we are here to talk about multiple options for the treatment of non-small cell lung cancer. Professor Peters presented data for the majority of patients with non-small cell lung cancer because in Western countries this population represents 90% of our patients. So it’s incredible to be here to think about multiple possibilities.

Just to go back to the story of non-small cell lung cancer. Five years ago we started with a single agent in second line and we observed that there were long-lasting responses for some patients. They were about 20% of the patients and they are still alive here after five years. The second point was the selection of patients. Three years ago in the plenary session we were here to discuss the possibility to treat patients in the first line setting, PD-L1 more than 50%, with single agent pembrolizumab. Last year was the year of the combination of chemotherapy and immunotherapy. This was, again, for all comers and it was irrespective of PD-L1 status. Now we are here to discuss the same possibility of combining two immunotherapies, anti-CTLA4 and nivolumab, ipilimumab and nivolumab, for the same population.

So nowadays we have three options. We can treat patients with single agent pembrolizumab, and also maybe yesterday with atezolizumab. We have the possibility to treat our patients with chemotherapy and immunotherapy. And now we have the possibility to treat patients with immunotherapy and immunotherapy.

What is the promise of the 227? The promise of the 227 is to have long-lasting responses, that means long life for our patients, with a chemo regimen sparing. But at the same time we have to go back to the bench and to the side and to act as scientists to understand who are the right patients to be treated with a combination with immunotherapy and immunotherapy, with a combination of chemotherapy and immunotherapy, and just with a single agent. We need some years to understand very well what is the right treatment algorithm but the good news is that nowadays, in 2019 in ESMO, we have the great option to have multiple possibilities to treat our patients.

I think that the voice of the patients will play a role. We’ll need time to discuss all these options with the patients. We are in the time of patient empowerment, of decision making, and I’m sure that also the patients will play a fundamental role in the decision for the first line treatment. Thank you for your attention.