PD-L1–High Advanced NSCLC: Future Directions in Care
Closing out her discussion on PD-L1–high metastatic NSCLC, Marina Chiara Garassino, MD, looks toward future evolutions in the treatment paradigm.
Case: A 72-Year-Old With Advanced NSCLC Cancer
Initial presentation
- KD is a 72 y/o female who presents to her primary care physician complaining of fatigue and a persistent cough.
- PMH:
- Hyperlipidemia (controlled)
- Anxiety (controlled)
- COPD (controlled)
- SMH: quit smoking 3 years ago and enjoys social drinking with her family
- FH: she lives alone but her kids and grandkids live nearby
- PMH:
Clinical workup
- Current Labs:
- CBC panel: Normal
- Liver function/Renal function: Normal
- PD-L1: 85%
- ECOG 1
- Molecular testing: (-) EGFR, ALK, ROS1
- CT scan of the head and neck showed a 5cm nodule in the right upper lobe of lung
- CT guided biopsy of the upper lobe confirms non-squamous cell carcinoma
- Abdominal CT scan shows liver metastases
- Diagnosis consistent with Stage IV non-small cell lung adenocarcinoma
Transcript:
Marina Chiara Garassino, MD: We saw great results in the last 15 years and an incredible increase of the overall survival expectancy in patients with metastatic non–small cell lung cancer. However, we’re in a situation where we don’t have biomarkers to select the best treatment for our patients. There are still some genomic alterations, like LKB1 or KIP1, for which the monotherapy may not be enough. We can give the chemotherapy and immunotherapy because they are bad prognostic markers. We don’t know what to do in the huge category of patients with performance status 2 because all the clinical trials suggested the benefit of chemotherapy and immunotherapy, and the immunotherapy alone, in patients with good performance status. We don’t know how to continue after chemotherapy and immunotherapy. There’s only docetaxel [Taxotere] plus or minus ramucirumab [Cyramza] or nintedanib [Ofev], which is our option. This is an option that we’d like to remove for our patients with metastatic non–small cell lung cancer in the second line.
It’s difficult to say what’s important and what’s not important. OX-40L, LAG3, TIM3, and TIGIT can represent new opportunities for our patients, but it’s unclear if 1 strategy is the best. In my opinion, we should work on the biomarkers more and try to understand the patients who must be treated with a particular type of new immune checkpoint inhibitors or with others. Other important strategies are the PARP inhibitors, the combinations with the antibody-drug conjugates, and the antiangiogenics.
Transcript edited for clarity.
