Patrick M. Forde, MBBCh, assistant professor of oncology, Johns Hopkins Hospital, discusses updates to the tumor, node, metastasis (TNM) staging system in lung cancer.

The updated TNM staging system has many clinical applications, explains Forde. Historically, when physicians have spoken about early-stage lung cancer and the use of systemic chemotherapy, physicians had to differentiate between stage Ib tumors and stage II tumors because some patients with stage Ib tumors greater than 4 cm received perioperative chemotherapy versus adjuvant chemotherapy for those with stage II disease. In the new set of guidelines, patients with stage Ib disease were moved into the stage II classification where they are now treated with adjuvant chemotherapy, says Forde.

Additionally, patients with oligometastatic lung cancer now have their own classification in the stage IV setting, recognizing that some of those patients may benefit from definitive treatment to both the primary tumor and also the solitary site of metastasis, says Forde.

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Dr. Forde on Updates to the TNM Staging System in Lung Cancer

Patrick M. Forde, MBBCh, assistant professor of oncology, Johns Hopkins Hospital, discusses the CheckMate-026 study, which demonstrated that first-line therapy with nivolumab failed to improve progression-free survival (PFS) in PD-L1—positive non-small cell lung cancer (NSCLC) compared with standard chemotherapy.

Nivolumab-treated patients had a median PFS of 4.2 months compared with 5.9 months for patients treated with a chemotherapy doublet chosen by the treating physician. Overall survival (OS) and response rate also did not differ significantly between treatment groups.

In the second-line treatment of lung cancer in patients that have already received platinum-based doublet chemotherapy, nivolumab does appear to prolong survival over chemotherapy. A lot of oncologists expected to see a similar finding in the first-line setting, says Forde.

It will be very important to look at the population of patients enrolled in the CheckMate-026 study and determine what characteristics of the tumor and the immune environment may have predicted or not predicted response to treatment. There is a lot of work to be done looking back at specimens from that trial to try and determine exactly why nivolumab did not improve survival in this study, says Forde.

Patrick M. Forde, MBBCh, assistant professor of oncology, Johns Hopkins Hospital, discusses the CheckMate-026 study, which demonstrated that first-line therapy with nivolumab failed to improve progression-free survival (PFS) in PD-L1–positive non-small cell lung cancer (NSCLC) compared with standard chemotherapy.
 

Dr. Patrick M. Forde on Next Steps After CheckMate-026 Study in NSCLC

Patrick M. Forde, MBBCh, assistant professor of oncology, Johns Hopkins Hospital, discusses   a study presented at ESMO 2016 on neoadjuvant nivolumab, in early stage resectable non-small-cell lung cancer (NSCLC).

Among the 18 evaluable patients included in the study, nivolumab appeared to be safe and well-tolerated and none of the patients that received it neoadjuvantly were delayed in going to surgery, says Forde. There were no unusual safety signals, says Forde.

In metastatic melanoma patients who received nivolumab in others studies, pneumonitis was common, says Forde. That was not the case with the early stage patients in this study so far.

Seven of 18 evaluable patients had significant pathologic responses after 2 doses of the PD-1 inhibitor prior to surgery. Radiographic evidence of response occurred in 22% patients.

Follow-up analysis will look at immunohistochemical changes with nivolumab treatment and also examine whether the tumor mutation profile may predict response in early-stage disease.

The study is expanding, so more patient will be enrolled with a slightly longer course of treatment, say Forde.

Patrick M. Forde, MBBCh

Articles

Dr. Forde on Updates to the TNM Staging System in Lung Cancer

Dr. Patrick M. Forde on Next Steps After CheckMate-026 Study in NSCLC

Dr. Patrick M. Forde on Neoadjuvant Nivolumab in NSCLC