Future Directions of Canakinumab and Unmet Needs in NSCLC

Edward B. Garon, MD, MS, professor of medicine, Geffen School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, discusses his thoughts on the data from the phase 3 CANOPY-A study (NCT03447769) and what they mean for the future of canakinumab (Ilaris) for patients with non–small cell lung cancer (NSCLC).

CANOPY-A study evaluated treatment with adjuvant canakinumab in patients with completely resected NSCLC. Data presented at the 2022 ESMO showed that the study failed to meet its primary end point of disease-free survival.

While Garon notes he is unsure of other places where there could be therapeutic utility with the agent across cancer, he looks forward to the future exploration of canakinumab. Garon also anticipates that research will rely on additional preclinical evaluation to examine the role of inflammation in lung cancer and discusses the unmet needs in the NSCLC space.

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0:08 | In the end, the only sort of questions we can answer with this data are the ones that were asked. I think that this data is clear that in the setting of resected non–small cell lung cancer, this is not an attractive avenue. I don't know if that means that there are not other places where there could be therapeutic utility across cancer, but what I would say is that I would anticipate future exploration of this will rely on additional preclinical evaluation looking at the role of inflammation in lung cancer.

0:50 | After many years of somewhat unimpressive advances or minimal advances in the setting of early stage, non–small cell lung cancer, there's been a tremendous amount of exciting data over the last few months to years looking at the role of immune checkpoint inhibitors in this early stage setting, as well as data looking at signal transduction inhibitors, and osimertinib [Tagrisso]. Still, we recommend cisplatin based chemotherapy for patients which is a sort of chemotherapeutic approach associated with a fairly high degree of toxicity. Overall, the efficacy is less than we would hope for.

1:42 | I think that an emerging question is for what to do in patients who receive neoadjuvant chemoimmunotherapy and do not have a complete response. Very nice work as part of the Checkmate-816 study [NCT02998528] showed the importance of nivolumab [Opdivo] plus chemotherapy as a potential approach that could improve outcomes in early-stage disease. The data was impressive, particularly for patients who achieved a complete pathologic response, which was about a quarter of the patients. In the other patients, it's not clear what the value was. I think 1 of the challenges that we will have is, what to do in that group of patients after they've completed their chemoimmunotherapy?