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DrCaudle
You previously reported similar out-
comes for resectable stage 3 non-small-cell
lung cancer tumors treated with induction
chemotherapy followed by either defini-
tive chemoradiotherapy or surgery in the
ESPATUE trial. In light of the recent advances
with immunotherapy in combination with
chemotherapy seen in the KEYNOTE-021
in the metastatic setting, what are your
thoughts about immunotherapy being uti-
lized in the neoadjuvant or definitive setting
for localized non-small-cell lung cancer?
Dr Eberhardt
With the studies in the recent
years in locally advanced non-small-cell lung
cancer stage 3, we’ve been through a time
where we most optimized the local regional
approach. The systemic approach was usu-
ally platinum-based chemotherapy, and at
the end of the day, still we find that only up
to 25% to 40% of the patients are cured, so
the patient relapse and die. The most impor-
tant issue currently is to improve the systemic
treatment in this lung cancer stage, so immu-
notherapy based on the results in stage 4,
is a very interesting new approach to use.
In recent weeks, we’ve already heard
through press release that there is a possi-
bility that with consolidation immunotherapy
we might improve the results for some of
the patients. So, we are eager to get new
results on this issue, and at this confer-
ence (ASCO 2017) we already have seen a
phase 2 trial looking at an immunotherapy
as consolidation. These results were pre-
sented here in the poster discussion, and
it is feasible, the toxicity is manageable, so
the hope is that through using immunother-
apy in these patients with stage 3 non-small
cell lung cancer, the systemic relapse can
be prevented in some patients.
Dr Caudle
Can you comment on some of
the current developments in the manage-
ment of malignant pleural mesothelioma,
and what are your thoughts regarding the
recent study showing benefit of adding of
target agents to chemotherapy?
Dr Eberhardt
Pleural mesothelioma is still a
disease with a large unmet need. We need
better systemic treatments. We have the
cisplatin and pemetrexed regimen, which
is a standard approach, but usually the
patient relapse. So we know that drugs,
VEGF-acting drugs, anti-angiogenic drugs,
and drugs acting on PD receptors, these
are interesting drugs. I mean, there is
data on bevacizumab in combination with
cisplatin/pemetrexed in the North American
Guidelines. The National Cancer Center,
the national guidelines also state that it
is possible to give bevacizumab in mes-
othelioma in combination with cisplatin/
pemetrexed.
It is not so much used in Europe, but in
the US you can use it, so we know that
targeted agents may improve the results
in some of the patients. We have seen at
this conference, also, that the new immu-
notherapy, the PD-1 or PD-L1 acting drugs,
these are interesting drugs because we’ve
seen that they work in some patients. And
it is possible, probably, also to give combi-
nations of chemotherapy with these new
antibodies, and probably thus we can
improve the systemic effect, and also by
improving the systemic effect we can also
have better local treatment.
Dr Caudle
What are some of the newer attrac-
tive agents or therapeutic developments
on the pipeline for treating mesothelioma?
Would you say it’s some of these PD-1 or
PD-L1s or are there other treatments that
you’re thinking about?
Dr Eberhardt
At the moment, I think there is
most interest in PD-1 and PD-L1 drugs and
there are trials ongoing. A randomized
phase 2 trial is going to be presented here
at ASCO that has quite interesting results,
and is probably the background for a fol-
low-up phase 3 trial. So phase 3 trials we
will need, but we know that patients who
have a high PD-L1 expression also that they
have a better response to PD-1 antibodies,
for instance, or PD-L1 antibodies, and so
also a patient selection could be possible,
and I think this will be progress for some
of the patients.
Upfront PD-1 inhibitor treatment for NSCLC:
a new paradigm
Dr Roy Herbst, Chief of Medical Oncology and the Associate
Director for Translational Research at the Yale Cancer Center
in New Haven, Connecticut, discusses the
impact of KEYNOTE 021 and 024 studies
on the upfront management of advanced
non-small cell lung cancer.
Critical issues in
thoracic oncology
Interview with Wilfried Eberhardt
MD
Dr Jennifer Caudle speaks with Dr Eberhardt, from the Department of
Medical Oncology at the West German Cancer Center at the University
Hospital Essen, University of Duisburg-Essen, on the use of immunotherapy
in the neoadjuvant setting for localised non-small cell lung cancer, and recent
developments in the management of malignant pleural mesothelioma.
Q & A
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PRACTICEUPDATE ONCOLOGY