New Immunotherapy Guidelines Will Help Clinicians Treat Lung Cancer

After the FDA approved Opdivo to treat non-small cell lung cancer (NSCLC) in March of 2015, it replaced cytotoxic chemotherapy as the main method of treatment for the disease. Immunotherapy has since become preferable to chemotherapy, as many new checkpoint inhibitors have also been FDA-approved. But because many immunotherapy treatments were introduced to the lab quite quickly, it has been difficult for doctors to keep up with the newest research, developments, and methods.

The Society for Immunotherapy of Cancer (SITC) has remedied this problem by creating the first set of guidelines that will help to guide practitioners in treating NSCLC with direct immune checkpoint inhibitior (ICI) treatments. Because of how rapidly immunotherapy research has expanded, the document itself is ever-changing, as researchers work to keep it up to date.

Roy S. Herbst, MD, PhD, and chief of Medical Oncology at Yale Cancer Center in New Haven, Connecticut, serves as the chair for the Cancer Immunotherapy Guidelines.  He believes this document to be of utmost importance in using immunotherapy to treat NSCLC. It’s not enough to simply have groundbreaking therapies. Doctors must also know how to use them. In a field that’s continually under investigation, a document like this is essential in keeping doctors up to date and allowing them to yield the most success in treating their patients.

Current Document Recommendations

The document currently outlines the treatment plan for patients with NSCLC, which starts with clinical, radiological, and pathological work-up that will provide more information about the tumor. Patients with advanced NSCLC who were recently diagnosed will also receive immunohistochemistry-based testing in order to show PD-L1 expression levels.

For first-line therapies, the document presently recommends that pembrolizumab (Keytruda) be used as a checkpoint blockade, either on its own or in combination with chemotherapy. Atezolizumab (Tecentriq), which was recently approved by the FDA, is another option that can be used in patients with metastatic NSCLC.

For second-line therapies, the document recommends Nivolumab and pembrolizumab, either on their own or together. It also recommends durvalumab (Imfinzi) for patients with advanced (locally), stage III cancer after chemotherapy and radiation.

According to Dr. Herbst, “immunotherapy plus chemotherapy is the standard of care in the frontline setting across all PD-L1 subtypes.” He adds, “Almost all patients should be getting immunotherapy now in the earliest possible stages.”

Regarding PD-L1 testing, Herbst and his team believe that its the best biomarker that’s available right now, but it still has shortcomings that can lead to sampling errors. Nevertheless, the team that made up the document all agreed that most patients with a NSCLC diagnosis should have the PD-L1 testing.

In order to measure the radiographic response in patients who have received immunotherapy, the document recommends two scans given at least 4 weeks apart. The scans should reveal any new lesions or increases in tumor size, both of which would point to disease progression.

The document will continue to be revised and updated by the panel of researches responsible for it. As groundbreaking research leads to new results, methods, and procedures, the team will evaluate the best courses of actions for patients with NSCLC and review the document accordingly.