ESMO 2023 | Dr. Naidoo reviews perioperative immunotherapy modalities for operable Non-Small Cell Lung Cancer
Editor's note: Immunotherapy for operable EGFR/ALK-negative non-small cell lung cancer (NSCLC) has gradually become the new standard of care. However, whether immunotherapy should be used preoperatively (neoadjuvant), postoperatively (adjuvant), or both pre- and post-surgery (the "sandwich" model) remains controversial. 2023 ESMO conference presented data from multiple perioperative immunotherapy trials, and Oncology Frontier invited Jarushka Naidoo of the Beaumont RCSI Cancer Center, Ireland, to discuss how immunotherapy can help improve the quality of care for NSCLC. Prof. Jarushka Naidoo of the RCSI Cancer Center to review the highlighted studies.
Oncology Frontier: Please introduce yourself,including your name, profession and where are you from?
Dr Naidoo: Good morning. My name is Jarushka Naidoo, and I am a Professor of Medical Oncology at the Beaumont RCSI Cancer Center in Dublin in Ireland. It is great to be here at the ESMO meeting, and to be able to give you some updates on recent advances in immunotherapy for lung cancer and beyond.
Oncology Frontier: Please introduce your presentation at 2023 ESMO meeting.
Dr Naidoo: Yesterday, I
presented the results of a large analysis examining the association between the
development of immunotherapy toxicity, immune-related adverse events, and
overall survival in patients treated with atezolizumab monotherapy or atezolizumab-containing
regimens, which is an anti-PD-L1 immunotherapy. This was a large analysis of
over 9000 patients, and individual patient level meta-analyses of several
trials, mostly including patients with lung cancer. What this study identified
was that if patients developed a low-grade toxicity (Grade 1 or 2) related to
immunotherapy or immunotherapy-based combination, they had a greater chance of
better overall survival. However, those patients who developed a high-grade
toxicity, particularly patients who developed high-grade pneumonitis and
high-grade colitis, this was associated with worse overall survival. These are
very important data, which help us guide our discussions with patients in the
clinic.
The second presentation, for which I was very pleased to serve as the discussant, was in the Lung Oral Abstract session. There were two presentations. One was given by Dr Jonathan Spicer, evaluating the overall survival data from the phase III KEYNOTE-671 study, examining the role of perioperative pembrolizumab in patients with early stage non-small cell lung cancer. This study is the first of the perioperative immunotherapy studies to demonstrate a statistically significant survival benefit, with a hazard ratio of 0.72, for overall survival. To recap, this is a phase III study in which patients with early stage resectable lung cancer received perioperative pembrolizumab (three cycles of cisplatin-based chemotherapy with pembrolizumab) followed by one year of pembrolizumab, compared to chemotherapy alone. This is what demonstrated the overall survival benefit.
The second abstract that I discussed was the exploratory cohort of ipilimumab and nivolumab treated patients on CHECKMATE-816. This was a phase III trial in which patients received upfront immunotherapy before surgery in early stage lung cancer. But in this cohort, patients received ipilimumab and nivolumab, so a chemo-free option (one dose of ipilimumab and three doses of nivolumab). This study was stopped early, but did show a very impressive signal for overall survival, with a hazard ration of 0.73, and an impressive pathologic complete response rate of 20%. I understand a modification of this approach may be studied in future studies. From here, I think the future of lung cancer and immunotherapy is very bright. It looks like immunotherapy is completely changing the face of early stage lung cancer. I think we will see a lot of studies utilizing different combinations of immunotherapy in the early stage setting, with the goal of trying to improve pathologic complete response and survival. I think some of the next stages are to validate pathologic complete response as a surrogate endpoint for overall survival, and that will help us to usher in a new era of curative therapy for lung cancer. Thank you.
Edited by: Liwei Chu