Lung Cancer Takes the Big Stage

By Jennifer King, Director of Science and Research at Lung Cancer Alliance

You may have seen news headlines about cancer advances last weekend. This is because it was the annual meeting of the American Society of Clinical Oncology (ASCO, a membership society for health professionals working in cancer) — a meeting of ~37,000 people that is known to be one of the best places to release high impact research results.

Some of our staff, including me, spent a few very busy days there and I’m thrilled to say that there is a lot to report. So much that I’m not sure how to fit it all into this blog – which is a great problem to have.

The Big Picture

First of all, the most important thing to say is that ASCO brought a lot of hope for those living with or at risk for lung cancer. Between the approval of screening coverage earlier this year and all the new drugs coming out, the terrible five year survival statistics for lung cancer will be changing.

At the meeting, I spoke to an oncologist who told me that in his rural community, 40% of patients who are diagnosed never go see their oncologist because they think a lung cancer diagnosis is a death sentence.  We have to change this attitude.  If people understood the dedication of health professionals to improving the lives of those with lung cancer and the pace of the research, everyone would see an oncologist to discuss their options.

Research  just about lung cancer was so impactful that the presentations were in the big rooms that seat ~5000 people

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Lung Cancer Session on Sunday at ASCO (Photo Credit: OncLive)

Even if you don’t want to read the scientific re-cap, here’s the big take-home points:

  1. There will be multiple more drug approvals in lung cancer by the end of the year
  2. Don’t give up hope
  3. Go talk to your doctor(s) regularly about your options if you are diagnosed or at risk for lung cancer

If you want more details on the science presented at the meeting, keep reading…

Immuno-Oncology

2015 seemed to be the year of Immuno-Oncology at ASCO.  Immuno-Oncology is using therapies that activate your own immune system to fight your cancer.  Although there are many types of immunotherapies, the kind making the most news right now are drugs that block two “checkpoints” called CTLA-4 and PD-1.

After I wrote my Opdivo (nivolumab) blog in March, a number of you asked me if it would work in non-squamous NSCLC.  At the time I didn’t have an answer, but I do now. Sure enough, a large research study shows a significant survival advantage of Opdivo (compared to Taxotere chemotherapy) in advanced non-squamous NSCLC and generally with fewer side effects.

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This made the front page of the meeting’s newspaper.

The key phrase at ASCO is always “practice-changing.”  A research study is practice-changing if it means that a doctor will actually change what he or she does or prescribes based on this new data.  This is what clinical researchers aspire to…making a difference in the care of patients.  This result was considered practice-changing and I’m sure we will be seeing Opdivo approved by the FDA for advanced, non-squamous NSCLC soon.

As mentioned in the Hot Topics on our website recently, there is also a competitor drug, Keytruda (pembrolizumab), that also targets PD-1 and is likely to receive FDA approval this year too. Notably, early data on both Opdivo and Keytruda in extensive small cell lung cancer was also presented. Both of the studies had promising results that indicated that some of the patients were having very favorable responses.  More research needs to be done in small cell, but this early data indicates that immuno-oncology drugs may eventually also be used in this type of lung cancer that has few options.

The data on immunotherapy in lung cancer look very promising, but there were also many questions raised.  In some studies, patients with higher levels of a protein called PD-L1 (which interacts with PD-1) were more likely to respond to these drugs. But this wasn’t true in all cases and it wasn’t clear how much PD-L1 needed to be present to make you more likely to respond.  There was also data presented  that suggested that the more DNA changes (mutations) you have in your tumor, the more likely you are to respond on a PD-1 drug.  This implies that former smokers might be more likely to respond to these drugs, but the data is not clear and some non-smokers do respond.

There is also an entire pipeline of additional drugs in this space that we will see over the next few years. This includes a PD-L1 inhibitor, atezolizumab (formerly MPDL3280A) which has already been designated a breakthrough therapy by the FDA.  Promising data was presented at the meeting on this agent too and there is a large clinical trial underway.

One very important advance across oncology was the presentation of combinations of immunotherapies.  There was huge news in melanoma that Opdivo was significantly better than Yervoy (ipilumumab), the CTLA-4 drug that was the original poster child for cancer immunotherapy. In this study, if patients did not have high levels of the PD-L1 protein, treatment with the combination of both Opdivo and Yervoy was even better than either drug alone.

This positive effect with combinations is likely to be true in lung cancer as well and there was early data presented that the Opdivo and Yervoy given together could be better in small cell (but needs more testing) as well as research on a very small number of patients with advanced NSCLC on both Keytruda and Yervoy, that showed disease control (no progression) in ~80% of patients.   So there is a lot of excitement for the future about combinations of immunotherapies along with combinations of immunotherapy and other types of agents.

All in all, there’s a huge buzz about immuno-oncology and we will see a lot more about these types of therapies in the coming year;  however,  there are still a number of questions to answer about how to use the drugs for the best patient results at the most reasonable cost.

Of note, pharmaceutical companies know this topic is confusing and are trying their best to educate patients and caregivers. Check out Bristol-Myers Squibb’s I-O page (where you can also raise a flag to honor someone  and support LCA) and this variation of “Angry Birds” from Genentech (that the science geek in me loves), where monoclonal antibodies slingshot to find the cancer cells that are “hiding” from the T-cells.

Check back next week for more data from the meeting on targeted therapies.