Future of NSCLC Immunotherapy Selection: Better Biomarkers and Who Benefits

In "Future of NSCLC Immunotherapy Selection: Better Biomarkers and Who Benefits," each panelist names the gap they would fix tomorrow and the shift they hope defines the field.

Dr. Cass closes by asking which one gap each panelist would fix tomorrow and which shift they hope will define the future of immunotherapy selection in non-small cell lung cancer.

Dr. Lynch wants more clarity on which patients will benefit from immune checkpoint inhibitor therapy. She notes that only about 20 to 30% of patients started on chemo-immunotherapy may truly benefit, yet clinicians cannot say exactly who they are. She wonders whether tumor molecular profiles or features of the underlying immune system could predict benefit. She hopes to learn when checkpoint inhibitor therapy alone, chemo-immunotherapy, or dual immunotherapy gives the most benefit, so patients are not exposed to unnecessary toxicity. Dual immunotherapy makes her nervous because anti-CTLA-4 therapy adds risk of immune-related adverse events, some of which, like myocarditis, require creative management.

Dr. Luon agrees. He wants better or new biomarkers because PD-L1 is imperfect. The panelists have all seen patients with PD-L1 of 0% respond well and patients with PD-L1 of 100% respond poorly, a pattern reflected in clinical trials. He also calls for consistency. Positivity cutoffs vary depending on whether expression is measured on tumor cells, immune cells, or both, and on whether a combined positive score is used. Finally, he wants to focus on the biology of remarkable responders, such as patients treated on early trials who remain in response, some of whom attend his clinic. Studies of their tumors could lead to new medications or help select patients for single-agent immunotherapy.

Dr. Cass says better biomarkers and better head-to-head clinical trials sum up both answers. She then thanks the panelists for a rich discussion and tells viewers she hopes they found this Pharmacy Times Practice Pearls program useful.

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