Stay tuned for coverage from the 2015 ASCO Annual Meeting. Today, Kumar Abhishek, a SERMO Oncologist shares research presented on small cell lung cancer.
Immunotherapy is the buzzword for ASCO 2015. Its everywhere. More than 50 different tumor types are being studied in a variety of clinical scenario and combination and setting. Lung cancer is one of the disease where the PD1 inhibitor have shown substantial benefit. Nivolumab is currently FDA approved for use in second line for metastatic squamous cell carcinoma of the lung. But the activity of Nivolumab and Pembrolizumab goes beyond squamous cell carcinoma.
There has been no new therapy approved for small cell lung cancer in the last 3 decades. The standard of care for the frontline treatment of extensive stage small cell lung cancer remains a combination of Platinum + Etoposide. The results of second line treatment with Topotecan is dismal. In comes immunotherapy. There were two studies which were presented today during the oral session. Preliminary safety and efficacy results from KEYNOTE-028 study looked at Pembrolizumab in patients with extensive stage small cell lung cancer (Abstract 7502). Patients were enrolled on the basis of PD-L1 expression. 27 patients among 135 (27%) tested positive for PD-L1 and 17 of them were enrolled and 16 ultimately received Pembrolizumab at a dose of 10 mg/kg, given every 2 weeks for upto two years or until confirmed progression or unacceptable toxicity. All 16 treated pts received prior platinum and etoposide. 9 pts (53%) experienced a drug-related adverse events; only 1 pt had a grade ≥ 3 adverse event. There were no treatment-related deaths or discontinuations due to adverse event. Four of 16 (25%) evaluable pts had a partial response. One (7%) pt had stable disease, resulting in a disease control rate of 31%. This is impressive result considering hard to treat disease i.e small cell lung cancer. PD-L1 expression is highly variable in tumor to tumor, site to site and there is significant discordance among pathologist regarding to the interpretation of the test. Moreover tumor with low expression of PD-L1 also benefit from anti-PD1 therapies. Thus by restricting the patient type to only PD-L1 expression, we may exclude patients who could potentially benefit from this therapy.
A second abstract presented today – Phase I/II study of nivolumab (NIVO) with or without ipilimumab (IPI) for treatment of recurrent small cell lung cancer (SCLC). Patients with progressive and/or refractory small cell lung cancer were enrolled regardless of tumor PD-L1 status or number of prior treatment regimens. They were randomized to NIVO 3 mg/kg every 2 weeks or NIVO+IPI (1 + 1 mg/kg, 1 + 3 mg/kg or 3 + 1 mg/kg) IV every 3 weeks for 4 cycles followed by NIVO 3 mg/kg every 2 weeks till progression or unacceptable toxicity. The current analysis included only the first two arms of the NIVO dosing. Seventy-five pts were enrolled, 40 in the NIVO monotherapy arm and 35 in the NIVO+IPI. Patients were heavily pretreated with close to 60% patients having received two or more prior regimens. Toxicity was manageable with grade 3 adverse event occuring in 6% of patients on the combination arm. ORR was 15% (NIVO) and 25% (NIVO+IPI) for evaluable pts; some achieved durable responses.
Kumar Abhishek is a board certified Hematologist-Medical Oncologist. He is employed by a large regional health system in Richmond, VA and works with the multi-specialty medical group. Dr. Abhishek received his medical degree from the University College of Medical Sciences located in Delhi, India, and completed his internal medicine residency from Carilion Clinic in Roanoke, Va. He also finished a fellowship in hematology and medical oncology from Saint Louis University in St. Louis, MO. Before starting his training in hematology and oncology, he worked as a clinical instructor and hospitalist at Allegheny General Hospital in Pittsburgh, Pa., and Chippenham Johnston-Willis Hospital in Richmond, Va.