Dr Langer on the Evolution of Adjuvant Immunotherapy in NSCLC

Corey J. Langer, MD, discusses how the use of adjuvant immunotherapy has affected the resectable NSCLC treatment paradigm.

“I think [OS advantages with adjuvant immunotherapy] will come. I think [they will] be particularly pronounced for the higher-stage patients, those with IIIA disease, and those who have higher levels of PD-L1 expression, particularly 50% or higher.”

Corey J. Langer, MD, director, Thoracic Oncology, Penn Medicine; and professor, medicine (hematology-oncology), the Hospital of the University of Pennsylvania, Perelman School of Medicine, discusses how the use of adjuvant immunotherapy has affected the resectable non–small cell lung cancer (NSCLC) treatment paradigm, as well as highlights unanswered questions in this arena.

Adjuvant therapy for patients with NSCLC was first used approximately 25 to 30 years ago, with multiple studies in the 1980s and 1990s demonstrating survival advantages with cisplatin-based regimens administered over a truncated course of approximately 4 cycles across 3 months, Langer begins. These studies collectively showed a modest but statistically significant absolute overall survival (OS) improvement of approximately 5% to 6%, he explains. However, for approximately 2 decades, little progress was made in the advancement of adjuvant treatment strategies, he says.

In recent years, advancements in the adjuvant setting have been observed, particularly with the introduction of immunotherapy, Langer notes. Two positive phase 3 clinical trials, IMpower010 (NCT02486718) and PEARLS/KEYNOTE-091 (NCT02504372), have demonstrated that administering single-agent immunotherapy in the form of atezolizumab (Tecentriq) and pembrolizumab (Keytruda), respectively, for 1 year following the completion of chemotherapy in patients with early-stage (stage IB-IIIA), resected NSCLC leads to a statistically significant and clinically meaningful improvement in progression-free survival compared with placebo, he states. However, an absolute OS benefit with immunotherapy in this setting has not yet been established, he emphasizes. Langer anticipates that OS advantages with adjuvant immunotherapy will become evident over time, particularly in patients with higher disease burden, such as stage IIIA disease, as well as those with PD-L1 expression of at least 50%.