Tanja Obradovic: Choosing immunotherapy treatment for early resectable NSCLC

Tanja Obradovic shared on LinkedIn:

“Choosing immunotherapy treatment options with PD(L)-1 inhibitors for early resectable non–small cell lung cancer (NSCLC) is complex and points to importance of evaluation of the sequence around surgery and timing compared to chemo with latest results of phase 3 ADJUVANT BR.31 trial of Durvalumab. Adjuvant Durvalumab did not lead to a statistically significant improvement in disease-free survival (DFS) compared with placebo after complete tumor resection in patients with stage IB to IIIA NSCLC with or without adjuvant chemotherapy and with PD-L1 expression on at least 25% of tumor cells.

This is in contrast to other PD(L)-1 compounds in the class. Atezolizumab, another PDL-1 inhibitor, is approved for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC patients whose tumors have PD-L1 expression on ≥ 1% of tumor cells (based on IMpower010). In this space, Pembrolizumab is also approved with platinum-containing chemotherapy as neoadjuvant treatment, and with continuation of single-agent Pembrolizumab as post-surgical adjuvant treatment for resectable NSCLC (based on Keynote -091). Interesting to point is that Pembrolizumab is approved in all-comers regardless of PDL-1 expression despite DFS not being significant in ≥50% PD-L1 expressers.

Nivolumimab has approval in the neaoadjuvant space as a chemo combo based on Checkmate-816 in stage IB to IIIA NSCLC patients regardless of PD-L1 expression. Results of Checkmate-427 trial of adjuvant Nivolumimab after surgery and chemotherapy in stage IB-IIIA NSCLC will reveal information for this approach (study is sponsored by NCI, NCT02595944, with projected finishing date 2025). In addition, PDUFA decision on Checkmate-77T and Nivolumimab neoadjuvant with adjuvant approach is coming in October this year.

Much more information about treatment options and complexity of choices in this space is coming in the future considering number of trials and options with targeted agents in addition to immunotherapy.”

Source: Tanja Obradovic/LinkedIn

Tanja Obradovic is the Vice President of Oncology Scientific Affairs at ICON PLCh. She has over 20 years of clinical research experience and has led major pharmaceutical companies for 13 years. Her research focuses on small molecules, antibodies, cell and gene therapy, and major immunotherapy of PD1 inhibitors.

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