Gilberto De Lima Lopes, MD, associate professor of clinical oncology and associate director of global oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the rationale to stop immunotherapy after 2 years in patients with lung cancer.

Long-term data from the phase 2/3 MK-3475-010/KEYNOTE-010 trial suggest that patients with non—small cell lung cancer who received pembrolizumab (Keytruda) for at least 2 years can continue to benefit from therapy after stopping, explains Lopes.

Some patients can develop chronic adverse effects (AEs) from immunotherapy, such as fatigue and arthralgias, says Lopes.

Financial toxicities can also impact the decision to stop immunotherapy, explains Lopes. Long-term treatment with immunotherapy may not be financially sustainable for patients.

Data suggest that stopping immunotherapy after 1 year of treatment could lead to inferior progression-free survival and overall survival, says Lopes. However, stopping after 2 years does not appear to negatively impact survival.

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Gilberto De Lima Lopes, MD, discusses the rationale to stop immunotherapy after 2 years in patients with lung cancer.


Dr. Lopes on the Rationale to Stop Immunotherapy After 2 Years in Lung Cancer

Gilberto De Lima Lopes, MD, associate professor of clinical oncology and associate director of global oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the rationale to stop immunotherapy after 2 years in patients with lung cancer.

Long-term data from the phase 2/3 MK-3475-010/KEYNOTE-010 trial suggest that patients with non–small cell lung cancer who received pembrolizumab (Keytruda) for at least 2 years can continue to benefit from therapy after stopping, explains Lopes.

Some patients can develop chronic adverse effects (AEs) from immunotherapy, such as fatigue and arthralgias, says Lopes.

Financial toxicities can also impact the decision to stop immunotherapy, explains Lopes. Long-term treatment with immunotherapy may not be financially sustainable for patients.

Data suggest that stopping immunotherapy after 1 year of treatment could lead to inferior progression-free survival and overall survival, says Lopes. However, stopping after 2 years does not appear to negatively impact survival.

Gilberto De Lima Lopes, MD, discusses the rationale to stop immunotherapy after 2 years in patients with lung cancer.

Gilberto De Lima Lopes, MD, associate professor of clinical oncology and associate director of global oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the FDA approval of nivolumab (Opdivo) and ipilimumab (Yervoy) in non–small cell lung cancer (NSCLC).

On May 15, 2020, the FDA approved the combination of nivolumab and ipilimumab for the first-line treatment of patients with metastatic or recurrent NSCLC that does not have 

 genomic tumor aberrations.

The approval is based on findings from part 1 of the phase 3 CheckMate-227 trial, in which nivolumab combined with ipilimumab demonstrated a significant improvement in overall survival (OS) compared with chemotherapy alone in patients with previously untreated NSCLC. In a cohort of patients with PD-L1 expression ≥1%, the median OS with nivolumab and ipilimumab compared with chemotherapy was 17.1 months and 14.9 months, respectively (HR, 0.79; 97.72% CI, 0.65-0.96; 

 = .007). Moreover, the median OS was 17.1 months with the combination and 13.9 months with chemotherapy in all randomized patients, regardless of PD-L1 expression status (HR, 0.73; 95% CI, 0.64-0.84).

The safety profile of the combination was also consistent with previously reported trials. The approval provides another option for patients in the frontline setting, says Lopes. How the dual immunotherapy combination will compare with that of chemotherapy has yet to be fully discerned, concludes Lopes.

Gilberto De Lima Lopes, MD, discusses the FDA approval of nivolumab (Opdivo) and ipilimumab (Yervoy) in non–small cell lung cancer (NSCLC).

Dr. Lopes on the FDA Approval of Nivolumab/Ipilimumab in NSCLC

Gilberto De Lima Lopes, MD, associate professor of clinical oncology and associate director of global oncology in the Sylvester Cancer Center at University of Miami Health System, discusses the standard of care for pembrolizumab (Keytruda) in patients with metastatic lung cancer.

Patients with stage III lung cancer receive pembrolizumab for a year, a timeline that was established in the PACIFIC trial, explains Lopes. Patients with metastatic disease should stop pembrolizumab if they experience progressive disease or toxicity. If the patient responds, they can continue treatment for up to 2 years before having a discussion regarding whether they want to continue or stop treatment, says Lopes.

Lopes often informs patients that it might be best to stop treatment after 2 years due to increased toxicity, but many patients resist the idea. The standard of care for pembrolizumab in patients with metastatic lung cancer is 2 years on the therapy, unless there is progression or toxicity, then stop. Other drugs do not have a stop rule in clinical trials, making the standard to continue treatment until progression or toxicity, concludes Lopes.

View more from the 2020 Winter Lung Cancer Conference

Gilberto De Lima Lopes, MD, discusses the standard of care for pembrolizumab in patients with metastatic lung cancer.

Gilberto De Lima Lopes, MD

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Dr. Lopes on the Rationale to Stop Immunotherapy After 2 Years in Lung Cancer

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