Dr Patel on Areas of Advancement in the NSCLC Treatment Landscape

Sandip P. Patel, MD, medical oncologist, professor, medicine, University of California (UC) San DiegoMoores Cancer Center, UC San Diego Health, discusses significant areas of advancement in the treatment paradigm for non–small cell lung cancer (NSCLC).

One of the most significant advancements in NSCLC management has been the integration of immunotherapy in earlier stages of the disease, offering the potential to cure more patients of their lung cancer, the leading cause of cancer-related deaths, Patel begins. This approach includes the use of neoadjuvant chemoimmunotherapy, he adds. For instance, the phase 3 CheckMate 816 trial(NCT02998528) regimen involves administering 3 cycles of chemotherapy combined with nivolumab (Opdivo) before surgery, Patel reports. Another strategy is perioperative chemoimmunotherapy, exemplified by the phase 3 KEYNOTE-671 trial (NCT03425643) regimen, which includes 4 cycles of chemotherapy plus pembrolizumab (Keytruda) followed by 1 year of pembrolizumab maintenance therapy, he states.

Although it remains unclear which approach is superior, as more mature data are awaited, both strategies are expected to increase the number of patients who become cured of NSCLC, Patel continues. A key metric in assessing the effectiveness of these therapies is the pathological complete response (pCR) rate, which measures the extent of tumor eradication in the surgical specimen, he elucidates. This metric helps evaluate how much of the tumor has been completely eliminated by the treatment, he adds.

A critical area of focus is understanding the prognosis for patients who do not achieve a pCR, he expands. For these patients, there is a concern about the potential for minimal residual disease, as evidenced by the shedding of tumor DNA into the blood even after treatment and surgery, Patel says. This raises the question of whether additional therapeutic intensification is needed to increase the likelihood of a cure, he imparts. This is where other agents and treatment modalities may come into play, potentially enhancing the effectiveness of the multimodality therapeutic approach and improving outcomes for patients with NSCLC, Patel concludes.