Videos

David Harpole, MD, discusses study design, results and clinical implications of the AEGEAN study of perioperative immunotherapy (neoadjuvant durvalumab plus chemotherapy followed by adjuvant durvalumab in the treatment of early-stage NSCLC

Perioperative Treatment in Early-Stage NSCLC: AEGEAN Study

Overview and clinical implications of the CheckMate-816 study of neoadjuvant nivolumab plus platinum chemotherapy versus chemotherapy alone in early-stage NSCLC.

Neoadjuvant Therapy in Early-Stage NSCLC: CheckMate-816 Study

Ben Levy, MD offers insight into how he approaches the selection of the optimal treatment strategy in early-stage non-small cell lung cancer.

Selecting Optimal Treatment in Early-Stage NSCLC

A panel of experts who treat patients with non-small cell lung cancer provides an overview of staging, molecular testing and treatment options in stage I-IIIB non-small cell lung cancer.

Overview of Early-Stage NSCLC and Molecular Testing

Sandip P. Patel, MD, associate professor, co-leader, Experimental Therapeutics, deputy director, San Diego Center for Precision Immunotherapy, director, Clinical Trials Office, Moores Cancer Center, University of California San Diego Health, discusses optimizing molecular testing for 

 mutations in patients with lung cancer, it is important to test for a range of mutations, including exon 19 mutations, L858R mutations, exon 20 insertions, and atypical 

 mutations like exon 18 alterations, Patel explains. Testing for specific 

 mutations is critical because the results will influence treatment selection. 

Therefore, utilizing precision oncology techniques in testing and treatment selection is important for patients with lung cancer, particularly as the field is gaining new targeted therapy options, Patel explains. For example, mobocertinib (Exkivity) and amivantamab-vmjw (Rybrevant) were both recently granted accelerated approvals from the FDA for use in patients with metastatic non–small cell lung cancer harboring 

 exon 20 insertion mutations. Other agents targeted against this specific mutation are also in clinical development. Therefore, testing for specific 

 mutations is critical to ensure patients are matched with the most appropriate therapy for their disease, Patel concludes.

Sandip P. Patel, MD, discusses optimizing molecular testing for EGFR mutations in lung cancer.  



Dr. Patel on Optimizing Molecular Testing for EGFR Mutations in Lung Cancer 

Sandip P. Patel, MD, associate professor, University of California, San Diego (UCSD), co-leader, Experimental Therapeutics, deputy director, San Diego Center for Precision Immunotherapy, director, Clinical Trials Office, UCSD Moores Cancer Center, UCSD Health Sciences, discusses novel targets in non–small cell lung cancer (NSCLC).

Research in NSCLC is generating significant enthusiasm for novel targets, Patel says. Some investigational targets, such as 

 fusions, are mRNA based and therefore best detected via RNA testing. Additional KRAS inhibitors directed toward pan-

 G12D mutations could shift the paradigm in NSCLC, Patel says. Novel immunotherapies, such as those directed toward TIGIT, as well as cellular therapies are also in development and could emerge for certain patient populations, Patel explains. 

However, practice-changing efforts in NSCLC have been localized to the early-stage setting recently, Patel says. For example, on October 15, 2021, the FDA approved atezolizumab (Tecentriq) for use as adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC whose tumors express PD-L1 of 1% or greater with the SP263 assay. Additionally, neoadjuvant nivolumab (Opdivo) in combination with chemotherapy improved pathologic complete response rate vs chemotherapy alone in patients with resectable NSCLC, suggesting this regimen could be a potential treatment option for patients. 

Obtaining molecular testing results prior to treatment selection is key to optimizing targeted options, Patel concludes. 

Sandip P. Patel, MD, discusses novel targets in non–small cell lung cancer.  



Dr. Patel Discusses Novel Targets in NSCLC 

Sandip P. Patel, MD, associate professor, University of California, San Diego (UCSD), co-leader, Experimental Therapeutics, deputy director, San Diego Center for Precision Immunotherapy, director, Clinical Trials Office, UCSD Moores Cancer Center, UCSD Health Sciences, discusses the utility of consolidative durvalumab (Imfinzi) in stage III non–small cell lung cancer (NSCLC).

The PACIFIC regimen, consisting of 1 year of durvalumab as consolidative therapy, is FDA approved for patients with unresectable stage III NSCLC whose disease has not progressed following concurrent platinum-based chemoradiation therapy. As nearly all patients respond to concurrent chemoradiation, the PACIFIC regimen has significant utility in this patient population, Patel explains. However, patients with underlying autoimmune conditions, such as idiopathic pulmonary fibrosis–related interstitial lung disease, may not be candidates for the PACIFIC regimen, Patel explains.

Notably, many patients who complete at least 1 month of concurrent chemoradiation develop toxicities, such as esophagitis, Patel says. However, data suggest that synergistic activity exists between immunotherapy and radiation therapy within 2 weeks after completion of chemoradiation. As such, starting patients on durvalumab approximately 2 weeks following chemoradiation completion could provide added benefit, Patel says.

Finally, in patients who receive weekly carboplatin plus paclitaxel, consolidative chemotherapy with 2 cycles of carboplatin plus paclitaxel every 3 weeks should not be given. Instead, patients should be started on consolidative durvalumab for 1 year, Patel concludes.

Sandip P. Patel, MD, discusses the utility of consolidative durvalumab in stage III non–small cell lung cancer. 



Dr. Patel on the Utility of Consolidative Durvalumab in Stage III NSCLC 

Sandip P. Patel, MD, a medical oncologist and associate professor of medicine at the University of California San Diego Health, discusses the potential of combining PARP inhibitors with immunotherapy for patients with non–small cell lung cancer (NSCLC).

A robust dataset has been emerging around the use of PARP inhibitors and PD-1 inhibitors for patients across a number 

 wild-type cancers, including ovarian and endometrial cancer, and other gynecologic malignancies, according to Patel. The dataset is of interest in NSCLC, although it is not clear as to why the combination has yielded positive results in this subset of patients, he explains.

The lung cancer community is anticipating emerging data in this area, as well as in combination with other therapeutics that will help to enhance PARP trapping, synthetic lethality, or immunogenicity. However, as monotherapy, there may not be a role for PARP inhibitors in thoracic malignancies for the foreseeable future, Patel concludes.

Sandip P. Patel, MD, discusses the potential of combining PARP inhibitors with immunotherapy for patients with non–small cell lung cancer.

Dr. Patel on the Potential With PARP/Immunotherapy Combos in NSCLC

Sandip Patel, MD, associate professor of medicine at the University of California San Diego School of Medicine, discusses the benefit of the immune checkpoint inhibitor combination of ipilimumab (Yervoy) and nivolumab (Opdivo) in patients with rare, high-grade neuroendocrine tumors.

For the phase II SWOG S1609 DART trial, investigators set out to assess the effectiveness of the anti—CTLA-4 immunotherapeutic ipilimumab (1 mg/kg every 6 weeks) plus the anti–PD-1 immune checkpoint inhibitor nivolumab (240 mg every 2 weeks), says Patel. The primary objective of the study is to measure tumor shrinkage by RECIST v1.1.

Investigators are evaluating each rare tumor cohort individually, and at the 2019 AACR Annual Meeting, Patel presented results from the neuroendocrine cohort. In this cohort, the combination was found to be efficacious in patients with high-grade disease with a 44% overall response rate compared with 0% in those with low or intermediate grade tumors. This benefit was seen irrespective of if the tumor originated in the lung, the gut, the gynecologic tract, or as an unknown primary.

Sandip Patel, MD

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