Megan Sanders, Chief Executive Officer at Thoracic Oncology Group of Australasia, shared on LinkedIn:
“Australia’s expanded PBS listing of nivolumab plus ipilimumab in metastatic cancers has opened an entirely new set of clinical questions for thoracic oncologists.
Until recently, Australian clinicians practised under a unique reimbursement model that limited immunotherapy in NSCLC to a single funded course, and in mNSCLC with a maximum treatment duration of two years.
At TOGA’s Annual Scientific Meeting, Malinda Itchins took us on a cook’s tour through this evolving landscape, exploring six practical clinical scenarios that clinicians are increasingly facing:
• Rechallenge after completing two years of immunotherapy.
• Recurrence following perioperative immunotherapy.
• Continuing treatment beyond two years.
• Rechallenge after immune-related toxicity.
• When combined PD-1/CTLA-4 blockade may have a role.
• Management after progression on immunotherapy.
The evidence is still evolving, with many decisions guided by retrospective studies and real-world data rather than prospective randomised trials.
Malinda’s take-home messages reflected this uncertainty, highlighting the need to individualise treatment, distinguish progression from true immune resistance, identify patients most likely to benefit from rechallenge, and generate stronger evidence through biomarkers and Australian real-world datasets such as AURORA and collaborative TOGA initiatives.”
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