Luis E. Raez, MD, FACP, FCCP, hematology and oncology, Medical Director, Chief Scientific Officer, Memorial Cancer Institute, Memorial Healthcare System, discusses the clinical implications of the phase 3 KEYNOTE-024 trial (NCT02142738) in non–small cell lung cancer (NSCLC).

The KEYNOTE-024 trial evaluated pembrolizumab (Keytruda) vs platinum-based chemotherapy regimens in patients with metastatic NSCLC. Now, 5-year survival have emerged, demonstrating clinically meaningful long-term overall survival benefit with the checkpoint inhibitor compared with chemotherapy, Raez says. This is important because less than 5% of this patient population could be cured only 20 years ago, but the 5-year survival data from KEYNOTE-024 showthe number has drastically increased. However, the utility of pembrolizumab in patients with metastatic NSCLC is dependent on PD-L1 expression, Raez explains.

The data are significant and some patients who received pembrolizumab remain in treatment-free remissions, Raez concludes.

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Luis E. Raez, MD, discusses the clinical implications of the phase 3 KEYNOTE-024 trial in non–small cell lung cancer. 


Dr. Raez on the Clinical Implications of the KEYNOTE-024 Trial in NSCLC 

Luis E. Raez, MD, medical director of Memorial Cancer Institute, and chief of Hematology/Oncology at Memorial Healthcare System, discusses the impact of PD-L1 status on immunotherapy outcomes for patients with non–small cell lung cancer (NSCLC).

Before administering a single-agent immunotherapy, it is important to check a patient's PD-L1 status, as it is currently the only available biomarker for this population, according to Raez. Although several potential biomarkers are under investigation, such as tumor mutational burden, current data are based on PD-L1 expression.

For all patients with lung cancer who do not have any actionable markers or genetic alterations, PD-L1 status is identified, Raez says. If PD-L1 expression is more than 50%, data from the phase 3 KEYNOTE-024 (NCT02142738) and KEYNOTE-042 (NCT02220894) studies indicate that patients will experience a statistically significant benefit from immunotherapy over chemotherapy; this has since become a standard of care in lung cancer, Raez concludes.

Luis E. Raez, MD, discusses the impact of PD-L1 status on immunotherapy outcomes for patients with non–small cell lung cancer. 

Dr. Raez on the Impact of PD-L1 Status on Immunotherapy Outcomes in NSCLC

Luis E. Raez, MD, medical director of Memorial Cancer Institute, and chief of Hematology/Oncology at Memorial Healthcare System, discusses the potential utility of cemiplimab-rwlc (Libtayo) in non–small cell lung cancer (NSCLC). 

Single-agent immunotherapy is a standard of care for patients with NSCLC whose PD-L1 expression is 50% or greater, explains Raez. Moreover, chemotherapy in combination with immunotherapy can be utilized for patients irrespective of PD-L1 status. 

Cemiplimab, a PD-1 inhibitor, has demonstrated improved efficacy versus chemotherapy for patients with locally advanced or metastatic NSCLC whose PD-L1 expression level is at least 50%, says Raez. A supplemental biologics license application for the agent received a priority review designation from the FDA in October 2020 for this indication based on findings from the phase 3 EMPOWER-Lung1 trial. 

Although the potential introduction of this agent to the lung cancer armamentarium is welcome, single-agent immunotherapies, including pembrolizumab (Keytruda) and atezolizumab (Tecentriq), are established in the space, Raez explains. As such, cemiplimab may not have widespread utility, and physician preference may be relied on for treatment selection, concludes Raez.

Luis E. Raez, MD, discusses the potential utility of cemiplimab-rwlc in non–small cell lung cancer.  



Dr. Raez on the Potential Utility of Cemiplimab in NSCLC 

Luis E. Raez, MD, medical director of Memorial Cancer Institute, and chief of Hematology/Oncology at Memorial Healthcare System, discusses the safety measures that have been put in place at Memorial Cancer Institute in response to the coronavirus disease 2019 (COVID-19) in lung cancer.

The symptoms related to COVID-19, particularly coughing, are also symptoms lung cancer, explains Raez. Patients with lung cancer are often smokers, and they may have chronic obstructive pulmonary disease, use inhalers, or be on prednisone. These factors may lead to coughing due to fluid or obstruction. Moreover, pneumonitis is a potential toxicity of radiation therapy and immunotherapy, says Raez.

In an attempt to differentiate the symptoms COVID-19 from those of lung cancer, patients are screened, and their temperature is taken when they come into the hospital, explains Raez.

Testing the patient’s blood for the COVID-19 antibody is a potential option to determine whether patients might be immune to COVID-19, says Raez. Relying on immediate COVID-19 tests would quickly deplete available resources for patients who frequently come into the clinic.

Finally, separating patients with COVID-19 who are tested in the emergency room from those with cancer could minimize the risk of exposure, concludes Raez.

Luis E. Raez, MD, discusses the safety measures that have been put in place at Memorial Cancer Institute in response to the coronavirus disease 2019 (COVID-19) in lung cancer.

Dr. Raez on Safety Measures to Combat Challenges of COVID-19 in Lung Cancer

Luis E. Raez, MD, medical director of Memorial Cancer Institute, and chief of Hematology/Oncology at Memorial Healthcare System, to discuss how the COVID-19 pandemic has impacted the treatment of patients with lung cancer.

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Luis E. Raez, MD, discusses how the COVID-19 pandemic has impacted the treatment of patients with lung cancer.

Dr. Raez on State of Lung Cancer Treatment in Light of COVID-19

Luis E. Raez, MD, medical director of Memorial Cancer Institute, and chief of Hematology/Oncology at Memorial Healthcare System, discusses the role of liquid biopsies in newly diagnosed patients with lung cancer.

In order to administer the appropriate targeted therapy to patients with lung cancer who may harbor 

 abnormalities, the molecular aberration must be found first, says Raez.

One way to detect these alterations is by performing a tissue biopsy; however, results from these tests take about 3 weeks to return, and oftentimes, patients have been living with their mass for around 2 months after its initial discovery, adds Raez. Furthermore, sometimes patients with stage IV disease will visit a surgeon first, which further delays the treatment process.

Patients are often given the choice between receiving immediate chemoimmunotherapy or waiting for the results of the biopsy to see whether targeted therapy is an option, according to Raez. To avoid those delays, patients might be more inclined to receive immediate treatment; however, if their tumor is harboring an alteration, that approach would be suboptimal, warns Raez.

Liquid biopsies can provide insight into whether a patient’s tumor is harboring a targetable mutation more quickly than a tissue biopsy. Results from liquid biopsies will return in just 8 to 9 days, which is the same amount of time it would take for an insurance provider to approve chemotherapy, says Raez.

With the appropriate targeted therapy, patients with 

 mutations can stay on treatment for 2 or 3 years, while those with 

 mutations can potentially remain on treatment for 5 years. Upon progression on these agents, patients can then receive chemoimmunotherapy and reap the benefits of that approach later on in their treatment journey, concludes Raez.

Luis E. Raez, MD, discusses the role of liquid biopsies in newly diagnosed patients with lung cancer.

Dr. Raez on the Benefits of Liquid Biopsies in Newly Diagnosed Lung Cancer

Luis E. Raez, MD, medical director and chief scientific officer of Memorial Cancer Institute, Memorial Healthcare System, discusses the impact of the KEYNOTE-407 trial in squamous non—small cell lung cancer (NSCLC).

For many years, squamous NSCLC has been behind in drug development because agents, such as pemetrexed and bevacizumab (Avastin), did not have indications for squamous cell carcinoma, explains Raez.

However, the KEYNOTE-407 study shifted the field when it showed that using pembrolizumab (Keytruda) with carboplatin and nab-paclitaxel (Abraxane) or paclitaxel as a frontline therapy for patients with squamous NSCLC improved disease-free survival and overall survival, concludes Raez.

Luis E. Raez, MD, discusses the impact of the KEYNOTE-407 trial in squamous non–small cell lung cancer.

Luis E. Raez, MD

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