ASCO 2023 | Choosing the best immunotherapy regimen for lung cancer

Natalie Vokes, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, explains that in stage 4 lung cancer, there are now many regimens that involve immunotherapy. However, there is little data comparing these different immunotherapies, as many trials use chemotherapy as a control. In clinical settings, data must be extrapolated from trials, alongside inclusion criteria, to provide patient with the best care. Research has found that initially, chemotherapy may be beneficial, especially in high-risk patients who may progress rapidly. However, there does not seem to be prolonged synergy between chemotherapy and immunotherapy. In patients with low disease burdens or high levels of PD-L1, it may be appropriate to use immune checkpoint monotherapy in first-line. Risks for early progression included, PD-L1, stage 4B versus 4A disease, trends towards liver metastases and smoking status. In these settings combination therapy may be beneficial. From a genomic point of view, CDKN2A mutations correlated with worse outcomes in combination chemotherapy and immunotherapy cohorts. Future research can hopefully explain this observation. This interview took place at the American Society of Clinical Oncology (ASCO) 2023 Annual Congress in Chicago, IL.

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