Hossein Borghaei, DO, MS, of Fox Chase Cancer Center, discusses emerging treatment options for patients with lung cancer.
The scientific community has made tremendous headway in the discovery and application of new therapies for lung cancer. Dr Hossein Borghaei, professor of thoracic oncology at Fox Chase Cancer Center, discusses recent developments in targeted therapies and immunotherapy, and discusses his recent research, which highlights the potential implications of immunotherapy plus chemotherapy as frontline therapy for lung cancer.
So the treatment landscape for adenocarcinoma lung cancer has changed dramatically in the past few years. Not only do we have more targeted therapies, we also have obviously introduced immunotherapy as part of the treatment algorithm for patients who qualify for it.
What we've recognized is that for some patients, those who have high PDL one expression defined as a PDA one score of 50% higher, it can effectively be treated with single agent pembrolizumab as a very effective and potent treatment strategy.
For those who have lower PDL one expression, a combination of chemotherapy and immunotherapy has become the standard of care. What I discussed was some of the recent updates in terms of long-term follow-ups and also the fact that now we have several different phase three studies with different either PD 1 or PDL 1 drugs combined with chemotherapy. For instance, we have studies with pembrolizumab and a couple of different chemotherapy platforms. We have studies with atezolizumab with the different chemotherapy backbones and basically all are showing a rather effective way of managing patients with adenocarcinoma of the lung.
What's also important to realize is that although in general there seems to be a little bit more side effect associated when you combine chemotherapy with the immunotherapy, there are two particular issues. One is that most of the side effects are still considered to be rather manageable, and second is that the rates of the immune related adverse events does not seem to be significantly higher.
We still have to pay attention to the side effect profile of the patients. For instance in keynote 189 where chemotherapy was combined with pembrolizumab, in this case the chemo backbone was carboplatin pemetrexed plus pembrolizumab there were higher rates of renal dysfunction associated with the regimen and obviously that is something that I think physicians have to be aware of and make sure they follow these patients rather closely so that if there is a change in the renal function, then that is pursued and investigated to make sure that the patient gets appropriate care.