The promise of immunotherapy

Shobha Shukla and Bobby Ramakant, CNS (Citizen News Service)
Prof David Carbone, President, IASLC
The five-year survival of lung cancer patients is historically low. Drug toxicity is another major challenge when it comes to cancer therapies. There is recent strong evidence that a new therapy – immunotherapy, which focuses on inhibiting either PD-1 or PD-L1 - has low toxicity and long-lasting anti-cancer effects in a subset of patients. This therapy promises to be a groundbreaking new approach to lung cancer. This new science also poses new questions: It works incredibly well for only some patients, so identifying a robust biomarker is essential.

IASLC Asia Pacific Lung Cancer Conference (APLCC 2016) is being held in Chiang Mai, Thailand and CNS (Citizen News Service) is the official media partner of APLCC 2016.

At APLCC 2016, Professor David Carbone, a globally recognized expert in this field, spoke about immunotherapy. Prof Carbone is the current President of the International Association for the Study of Lung Cancer (IASLC); Professor in the Division of Medical Oncology; and leads the James Thoracic Oncology Center at Ohio State University in the USA. He has an active research lab and has published hundreds of research papers on lung cancer throughout his career.

Second and third generation inhibitors reduced toxicity, improved efficacy

When Prof Carbone started treating lung cancer 25 years ago, there were very few treatment options available. Most lung cancer patients had no treatment at all, and any treatment options were very toxic and not very effective.

“About 10 years ago, we discovered driver genetic mutations that could be specifically inhibited by drugs and showed dramatic responses in patients in terms of improved symptoms and prolonged survival. This was a big revolution in lung cancer therapy. Today, we do not treat non-small cell lung cancer (NSCLC) without knowing the genetic profile of the patient. In the last couple of years, we had the introduction of new second and third generation inhibitors for these targets that have even better efficacy and reduced toxicity for lung cancer patients,” Prof Carbone said.

The immunotherapy era: New revolution in lung cancer treatment

Prof Carbone added, “Driver oncogene targets are only found in about a quarter of patients of lung cancer in the U.S. So, there are still a large number of patients who do not have these genetic targets. Excitingly, in the last couple of years we have a new treatment modality that may be particularly effective in patients without these driver mutations – this is called immunotherapy. This is a type of therapy that harnesses your own body’s immune system to attack your cancer. Current drugs that are approved for this therapy are generally very well tolerated with serious-adverse-events rate of less than 5 percent.”

“Significant clinical activity is seen in about 25 percent of patients, or even higher if patients with tumors over-expressing PD-L1 are selected. This clinical response is unusually long-lasting as well, with many of these responding patients having very durable shrinkage of their cancers with minimal toxicity. It clearly is a revolution in the treatment of lung cancer.”

Questions remain, research continues

“What we are striving to do now is to figure out the best way to select patients for this therapy and to figure out additional immunotherapies that may work in a patient who does not respond to PD-1 pathway inhibitors. One exciting thing about the discovery of mutations in EGFR and targeted therapy was the possibility that we may uncover other molecular targets. We did just that with BRAF, ROS, ALK, TRK, and many others. I have the hope that the efficacy of PD-1 pathway therapy is ‘just the tip of the iceberg,’ and that there may be many potential immunotherapy targets that are yet to be discovered for patients who do not benefit from targeted therapies for PD-1 pathway inhibitors,” Prof Carbone said.

“These are exciting times where we have new agents and we are trying to learn how to best combine them with targeted therapy, chemotherapy, radiation, or surgery. Meetings like the APLCC 2016 are the perfect place to allow investigators to gather and share the latest data available on these therapies and their combinations. This will help lead delivery of these state-of-the-art therapies to patients throughout the world and IASLC is proud to be supporting this process,” Prof Carbone said.

Shobha Shukla and Bobby Ramakant, CNS (Citizen News Service)
14 May 2016