Dr Desai on Unmet Needs With Chemoimmunotherapy in NSCLC

Aakash Desai, MBBS, MPH, assistant professor, medicine, O'Neal Cancer Center, University of Alabama at Birmingham, discusses unmet needs with the treatment of chemoimmunotherapy in patients with non–small cell lung cancer (NSCLC), highlighting that patients will typically progress on this treatment approach. Furthermore, Desai highlights ongoing research in the NSCLCtreatment armamentarium that will further evaluate these unmet needs.

Immunotherapy has significantly improved outcomes for patients with lung cancer, particularly for those with NSCLC who do not have oncogene-driven forms of the disease, Desai begins. However, despite the benefits of chemo-immunotherapy, tumor progression eventually occurs in many patients, necessitating the need for second-line treatments in advanced NSCLC cases, he explains. The current standard of care for these patients remains chemotherapy with docetaxel, with or without the addition of ramucirumab (Cyramza), in accordance with both national and international guidelines, he reports. Although numerous clinical trials have sought to improve upon these treatments, no new agents have been approved for this indication, he remarks.

For patients experiencing oligoprogression—progression limited to 2 to 5 metastatic sites—continuing immunotherapy alongside stereotactic body radiation therapy (SBRT) as localized treatment is a viable option, provided the immunotherapy is well tolerated, Desai continues. Thephase 2 CURB trial demonstrated an improvement in progression-free survival for patients with NSCLC, as well as those with breast cancer, who received SBRT in addition to immunotherapy vs immunotherapy alone, he elucidates. This strategy is commonly employed in NSCLC clinical practice today, especially for patients with oligoprogressive disease, Desai adds.

Desai emphasizes that this treatment approach allows for the continuation of immunotherapy, which is generally well tolerated. However, the SBRT component also addresses specific progressive lesions with targeted radiation, he notes. This combination has proven to be an effective treatmentstrategy for select patients, helping to manage the disease more effectively and potentially prolonging the benefits of initial treatments, Desai concludes.