Balazs Halmos, MD, MS, director of thoracic oncology and director of clinical cancer genomics, Montefiore Medical Center, discusses second-line treatment for patients with metastatic squamous non—small cell lung cancer (NSCLC).

If a patient progresses on chemoimmunotherapy in the first-line setting, their options are limited in the second-line, explains Halmos. As it stands, the standard of care for the management of metastatic nonsquamous NSCLC, metastatic squamous cell lung cancer, and extensive-stage small cell lung cancer should be a combination of chemotherapy and immunotherapy, says Halmos.

While second-line chemotherapy does benefit patients, benefits that can be enhanced in the right subsets with the addition of ramucirumab (Cyramza), physicians must work harder to achieve more than what second-line chemotherapy can do, says Halmos. Physicians need to understand the mechanisms of resistance to immunotherapy and focus on individualized strategies in terms of chimeric antigen receptor T cells and other classes of agents. There is a lot of research that physicians still need to do, though a lot has been accomplished, Halmos concludes.

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Balazs Halmos, MD, MS, director of thoracic oncology and director of clinical cancer genomics, Montefiore Medical Center, discusses second-line treatment for patients with metastatic squamous non–small cell lung cancer (NSCLC).

Dr. Halmos on Second-Line Treatment in Metastatic Squamous NSCLC

Balazs Halmos, MD, MS, director of thoracic oncology and director of clinical cancer genomics, Montefiore Medical Center, discusses the use of immunotherapy in the treatment of patients with metastatic squamous non—small cell lung cancer (NSCLC).

Within the last year, physicians have seen frontline data from the IMpower131 and KEYNOTE-407 trials. IMpower131 looked at the combination of taxane-based doublet chemotherapy plus atezolizumab (Tecentriq). Though the study had shown significant progression-free survival (PFS) benefit, it failed to translate into an overall survival (OS) benefit, says Halmos.

The KEYNOTE-407 study looked at the combination of carboplatin/paclitaxel or nab-paclitaxel (Abraxane), plus or minus pembrolizumab (Keytruda). This was followed by maintenance pembrolizumab versus placebo. The addition of pembrolizumab showed a PFS benefit as well as a substantial OS benefit, irrespective of PD-L1 expression, adds Halmos. This translated to an approximately 20% improvement in response rates, changing the frontline standard, concludes Halmos.

Balazs Halmos, MD, MS, director of thoracic oncology and director of clinical cancer genomics, Montefiore Medical Center, discusses the use of immunotherapy in the treatment of patients with metastatic squamous non–small cell lung cancer (NSCLC).

Balazs Halmos, MD, MS, Montefiore Einstein Center for Cancer Care

Articles

Dr. Halmos on Second-Line Treatment in Metastatic Squamous NSCLC

Dr. Halmos on Immunotherapy in Squamous NSCLC