Advances in Non-Small Cell Lung Cancer: An Oncologist's Perspective

Hossein Borghaei, Fox Chase Cancer Center - a physician in the field of cancer care - discusses his experiences treating patients with non-small cell lung cancer and why recent data is now available and could have a positive impact on the treatment landscape. 
BY Sponsored Content
PUBLISHED August 28, 2019
Sponsored by Bristol-Myers Squibb

Lung cancer is the second most common cancer in men and women, and accounts for approximately 13% of new cases of cancer in the U.S. It is also the leading cause of cancer death among both men and women.

Fortunately, clinical advances have begun to shift the outlook for patients diagnosed with lung cancer, including those with non-small cell lung cancer (NSCLC), which accounts for 80%-85% of lung cancer cases.

Hossein Borghaei, DO, chief of the Division of Thoracic Medical Oncology at Fox Chase Cancer Center, has been treating patients for more than 15 years. Learn more about his perspective on NSCLC, recent treatment innovations and how these are impacting survival rates for some patients with the disease.

You have cared for patients facing advanced NSCLC and been involved in clinical research for many years. How has the medical community’s approach to treating advanced NSCLC evolved during that time?

While statistics are improving, we also face the reality that more than an estimated 228,000 new cases of lung cancer will be diagnosed in 2019 in the U.S., and more than 142,000 deaths will result from this disease. Many of my patients have advanced NSCLC, a difficult-to-treat form of lung cancer associated with a prognosis that –until recently– has typically been measured in months.

This unmet need has motivated me and others in my field to identify treatment approaches that may offer improved outcomes for patients.

When considering treatment for NSCLC, the stage at which it is diagnosed and each particular patient’s needs impact the approach taken. Treatment options have included surgery, radiation and traditional chemotherapy. In more recent years, treatments such as immunotherapies and targeted therapies have emerged as important approaches for some NSCLC patients. Immunotherapy works differently from other forms of treatment, as it helps stimulate the patient’s immune system to identify and destroy cancer cells. In some cases, these treatments can cause a patient’s T cells to attack healthy cells contained within organs and tissues in any area of the body and can affect the way they work.

What do you find most exciting about cancer research today?

Over the last two decades, we’ve made great progress in our understanding of cancer, including gleaning insights into how the disease develops and the ways in which it avoids detection by the body. Collectively, we’ve been able to build on this understanding and apply insights to the development of new approaches and treatments.

As these treatments have advanced and made their way to patients in clinical trials, we've been able to track patients over time. This allows us to collect data that may ultimately help inform how doctors treat the disease.

You refer to “new data.” Can you explain why these data are important and how they impact patients?

Recently, researchers presented longer-term data from a follow-up analysis of two Phase 3 trials of Opdivo® (nivolumab) in certain patients with NSCLC. The findings showed more patients treated with Opdivo were alive at four years than those treated with chemotherapy (docetaxel), which underscores the strides that have been made in the fight against the disease.
 
Opdivo is an immunotherapy approved by the FDA for adults with advanced NSCLC that has spread or grown and if platinum-based chemotherapy did not work or is no longer working. If patients’ tumors have an abnormal EGFR or ALK gene, they should have also tried a U.S. Food and Drug Administration (FDA)-approved therapy for tumors with these abnormal genes, and it did not work or is no longer working. It is not known if Opdivo is safe and effective in children younger than 18 years of age. Opdivo will not work for every patient, and results may vary.

Opdivo can cause problems that can sometimes become serious or life threatening and can lead to death. Serious side effects may include lung problems (pneumonitis); intestinal problems (colitis), that can lead to tears or holes in your intestine; liver problems (hepatitis); hormone gland problems (especially the thyroid, pituitary, adrenal glands and pancreas); kidney problems, including nephritis and kidney failure; skin problems; inflammation of the brain (encephalitis); problems in other organs; and severe infusion reactions.

The survival benefit of Opdivo in certain patients with advanced NSCLC who received prior treatment was demonstrated in the initial results from a primary analysis of two separate clinical trials. These trials studied Opdivo in patients with two types of lung cancer, either squamous or non-squamous NSCLC, and the patients had to have tried a previous treatment of a platinum-based chemotherapy, but their cancer had spread or grown.

In the initial and primary trial analysis, half of the 292 patients with previously treated advanced non-squamous NSCLC were alive 12.2 months after starting treatment with Opdivo, versus 9.4 months for the 290 patients who received a type of chemotherapy called docetaxel. Overall, the risk of dying was reduced by 27% with Opdivo compared to chemotherapy (docetaxel). Of the patients with previously treated advanced squamous NSCLC, half of the 135 patients treated with Opdivo were alive 9.2 months later, compared to 6 months for the 137 patients that received chemotherapy (docetaxel). Overall, the risk of dying was reduced by 41% with Opdivo compared to chemotherapy (docetaxel).

In addition to demonstrating superior overall survival versus chemotherapy in the primary analyses of these trials, after four years, Opdivo continued to show survival versus chemotherapy (docetaxel). In fact, more patients treated with Opdivo in these trials were alive four years after starting treatment as compared to those treated with chemotherapy (docetaxel).

Specifically, in a follow-up analysis at four years:
  • In the trial of patients with squamous NSCLC, 16 patients (13%) who had received Opdivo were still alive (n=135), versus six (4%) of those receiving chemotherapy (docetaxel) (n=137).
  • In the trial of patients with non-squamous NSCLC, 39 patients (15%) who had received nivolumab were still alive after four years (n=292), versus 13 patients (5%) who received chemotherapy (docetaxel) (n=290).  
The most common side effects of Opdivo when used alone include: feeling tired; rash; pain in muscles, bones, and joints; itchy skin; diarrhea; nausea; weakness; cough; vomiting; shortness of breath; constipation; decreased appetite; back pain; upper respiratory tract infection; fever; headache; and abdominal pain. Please see additional Important Safety Information below.

As the lung cancer community continues to work toward the goal of helping patients live longer, what sort of advice would you give to patients going through this?

As scientific advances continue to progress, we strive to improve outcomes for patients. However, we can’t lose sight of the impact cancer has on the lives of patients and their loved ones not only during, but after treatment.

To help patients through their care, both at home and with their oncologist, there are a number of strategies that can help. This might include making a timetable for forthcoming checkups or tests, ensuring the right care team is in place, positivity and having a good support system.   

Additionally, there are a number of advocacy groups focused on providing resources to those impacted by cancer. This includes Cancer Support Community (www.CancerSupportCommunity.org) and the National Coalition for Cancer Survivorship (www.CancerAdvocacy.org).

Where can patients learn more about Opdivo?
You can visit Opdivo.com to learn more about this treatment option and other helpful information including an inspiring patient story, questions to ask your doctor and additional supportive resources for both patients and caregivers.

Please see Important Safety Information for Opdivo below. Please see U.S. Full Prescribing Information and Medication Guide for Opdivo.

INDICATION
OPDIVO® (nivolumab) is a prescription medicine used to treat people with a type of advanced stage lung cancer (called non-small cell lung cancer) that has spread or grown and you have tried chemotherapy that contains platinum, and it did not work or is no longer working. If your tumor has an abnormal EGFR or ALK gene, you should have also tried an FDA-approved therapy for tumors with these abnormal genes, and it did not work or is no longer working.

It is not known if OPDIVO is safe and effective in children younger than 18 years of age.

Important Safety Information for OPDIVO® (nivolumab)
OPDIVO is a medicine that may treat certain cancers by working with your immune system. OPDIVO can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become serious or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended.

Serious side effects may include:
  • Lung problems (pneumonitis). Symptoms of pneumonitis may include: new or worsening cough; chest pain; and shortness of breath.
  • Intestinal problems (colitis) that can lead to tears or holes in your intestine. Signs and symptoms of colitis may include: diarrhea (loose stools) or more bowel movements than usual; blood in your stools or dark, tarry, sticky stools; and severe stomach area (abdomen) pain or tenderness.
  • Liver problems (hepatitis). Signs and symptoms of hepatitis may include: yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); drowsiness; dark urine (tea colored); bleeding or bruising more easily than normal; feeling less hungry than usual; and decreased energy. 
  • Hormone gland problems (especially the thyroid, pituitary, adrenal glands, and pancreas). Signs and symptoms that your hormone glands are not working properly may include: headaches that will not go away or unusual headaches; extreme tiredness; weight gain or weight loss; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness; hair loss; feeling cold; constipation; voice gets deeper; and excessive thirst or lots of urine.
  • Kidney problems, including nephritis and kidney failure. Signs of kidney problems may include: decrease in the amount of urine; blood in your urine; swelling in your ankles; and loss of appetite.
  • Skin Problems. Signs of these problems may include: rash; itching; skin blistering; and ulcers in the mouth or other mucous membranes.
  • Inflammation of the brain (encephalitis). Signs and symptoms of encephalitis may include: headache; fever; tiredness or weakness; confusion; memory problems; sleepiness; seeing or hearing things that are not really there (hallucinations); seizures; and stiff neck.
  • Problems in other organs. Signs of these problems may include: changes in eyesight; severe or persistent muscle or joint pains; severe muscle weakness; and chest pain.
Getting medical treatment right away may keep these problems from becoming more serious.

Your healthcare provider will check you for these problems during treatment. Your healthcare provider may treat you with corticosteroid or hormone replacement medicines. Your healthcare provider may also need to delay or completely stop treatment, if you have severe side effects.

OPDIVO can cause serious side effects, including:
  • Severe infusion reactions. Tell your doctor or nurse right away if you get these symptoms during an infusion of OPDIVO: chills or shaking; itching or rash; flushing; difficulty breathing; dizziness; fever; and feeling like passing out.
Pregnancy and Nursing: 
Tell your healthcare provider if you are pregnant or plan to become pregnant. OPDIVO can harm your unborn baby. Females who are able to become pregnant should use an effective method of birth control during and for at least 5 months after the last dose of OPDIVO. Talk to your healthcare provider about birth control methods that you can use during this time. Tell your healthcare provider right away if you become pregnant during treatment. Before receiving treatment, tell your healthcare provider if you are breastfeeding or plan to breastfeed. It is not known if OPDIVO passes into your breast milk. Do not breastfeed during treatment.

Tell your healthcare provider about:
  • Your health problems or concerns if you have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus; have had an organ transplant; have lung or breathing problems; have liver problems; or have any other medical conditions.
  • All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
The most common side effects of OPDIVO when used alone include: feeling tired; rash; pain in muscles, bones, and joints; itchy skin; diarrhea; nausea; weakness; cough; vomiting; shortness of breath; constipation; decreased appetite; back pain; upper respiratory tract infection; fever; headache; and abdominal pain.

These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see U.S. Full Prescribing Information and Medication Guide for OPDIVO.

Opdivo® is a trademark of Bristol-Myers Squibb Company. (C) 2019 Bristol-Myers Squibb Company. All rights reserved.

1506US1900864-01-01 08/19

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