Immune Checkpoint Therapy in NSCLC
Finally, a great deal of excitement was generated over data with nivolumab, an anti-PD-1 immune checkpoint inhibitor that has shown efficacy in melanoma and is now showing promise in non-small-cell lung cancer (NSCLC). Three presentations on the use of nivolumab in patients with heavily pretreated, advanced NSCLC were reviewed. In this difficult-to-treat population, nivolumab monotherapy resulted in a median overall survival (OS) of 9.2 to 14.9 months and 1- and 2-year OS rates of 32% to 56% and 12% to 45%, respectively (Brahmer JR, et al. ASCO 2014. Abstract 8112). Moreover, nivolumab given in combination with platinum-based doublet chemotherapy in chemotherapy-naïve patients with advanced NSCLC resulted in an overall response rate of 33% to 50%, with an acceptable tolerability profile (Antonia SJ, et al. ASCO 2014. Abstract 8113). Nivolumab monotherapy is now being tested in a phase 3 trial in chemotherapy-naïve patients with stage IV or recurrent NSCLC with PD-L1-positive tumor expression to determine if it can improve progression-free survival and quality of life in patients with advanced disease (Carbone DP, et al. ASCO 2014. Abstract TPS8128).
These data with novel agents in patients with heavily pretreated advanced NSCLC begs the question as to whether end-of-life discussions should occur with these patients or whether they should be offered these expensive new agents. This is an ethical question that will be addressed at this ASCO meeting, and we will report on this issue in subsequent updates.