Immunotherapy Update for Lung Cancer: What Kind of Patients Will Benefit?

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Topics include: Treatment and Understanding

The novel class of immunotherapy drugs, referred to in the media as the remarkable game-changer in Jimmy Carter’s treatment strengthens the body’s natural defenses to seek out and target cancer cells. How are patients selected for this type of treatment? Lung cancer experts, Dr. Edward Kim and Dr. Jeffrey Crawford share exciting progress made in immunotherapy, how patients are identified and selected as candidates, and the role biomarkers plays in developing a treatment plan. Can these markers help predict patient response? Watch now to find out more.

This is a Patient Empowerment Network program produced by Patient Power. We thank Celgene and Pfizer for their support.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

And lung cancer is one of the largest.  It affects so many people out there, and to have these trials testing immunotherapies and these FDA indications, has really transformed things.  What we explain to people is that it's not like the vaccine programs in the past in that the immune system is a very sort of gray area for a lot of folks.  Some people think you can take vitamins and boost your immune system.  Other people think you just have healthy living it will do it, and all those things contribute because your immune system is really like your micro environment throughout your entire body, and a lot of things affect it, and it affects a lot of things.  

But what's really cool about these newer generation drugs that are impacting the cancer process is that cancers have become smart.  They are able to build up defenses to be sort of stealth inside the body, and so even though there were bad things happening to you your body couldn't tell that they were cancer cells versus normal cells.  And so these new checkpoint inhibitors have focused on trying to break down the stealth or the defenses that these cancer cells have been using to invade the immune system.  

And so now you're really empowering your own body's immune system to fight the cancer.  And that's really exciting.  The side effects, there are some but have generally been very well tolerable.  There are always a percentage of patients who can get a hyperactive immune system, and that's usually what causes a lot of symptoms we see, but all in all—you know, we use Jimmy Carter as a poster child, he's like 150 years old, and he's on an immunotherapy being treated for a stage IV melanoma and doing very well. So that's what my patients see out there, that's why they're asking about it.  We have to select the right people who is appropriate.   

So what's really cool about this is that the immune system itself is what destroys the cancer when you take these agents.  This is not like chemotherapy or even targeted therapy where there's a direct cytotoxic effect on the cells.  This is really enabling your immune system to take over and attack the cancer and destroy it. So it's remarkable when we see an X-ray with cancer disappearing based on restoring the immune system.   

So PD-L1 is clearly an important marker because it's the way these first-generation immune checkpoint inhibitors work through that process.  So one would assume that the PD-L1 measurement would be predictive of who is going to benefit and who is not.  And in some sense it is, but it's not at all like EGFR testing, where we are pretty confident when we have an EGFR mutation we'll have a very high response rate, while with PD-L1 even in patients with expression above 50 percent only about half of them get a good response.  

And on the other end patients with very low response, very low levels of PD-L1, they still have a response of 8 or 10 percent. So it's not a perfect marker by any means, but it has been helpful in identifying patients likely to benefit. And what's come out of ASCO is more and more about how to select patients for immunotherapy or a combination of chemo and immunotherapy or other options.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on April 5, 2019