BTOG 2021 | Immunotherapy for operable lung cancer

Hello everybody, my name is Samreen Ahmed. I’m a medical oncologist at the University Hospitals of Leicester, and I was in a privileged situation to present immunotherapy going into operable disease at BTOG 2021 virtual meeting.

And just to start off with really, BTOG, as always, delivered what it had promised, and Gina and Dawn have done a wonderful job. And the virtual team have done an amazing job at getting it all together. So, my talk, I had a very specific brief from our chairman to talk about immunotherapy, which has obviously changed cancer treatments for all cancers, but in non-small cell lung cancer it’s really changed the whole landscape over the last five years. And so, I just went through the pivotal studies which have taken place in advanced lung cancer. Then showed how the whole space is now moving into earlier stage lung cancer. And then, so stage three lung cancer, and hopefully the outcomes we’re seeing at four years for stage three lung cancer are equivalent to those coming out for earlier stage three surgery even, and we’ll see what the five-year outcomes for the PACIFIC study are.

So then the main point of my talk was how immunotherapy and chemotherapy combinations are changing the landscape of surgery. And so, preoperative chemotherapy and immunotherapy is now being tested. And the thrust of the talk was looking at safety, feasibility, is it deliverable? Does this treatment upfront make surgery more difficult? And the pivotal study, CheckMate 816, presented very recently at AACR a fortnight ago, really hot off the press by Patrick Forde. I went through some of his slides really showing that A, we can deliver the chemotherapy, immunotherapy upfront, but most importantly, the primary endpoints of that study were met, i.e., pathological response rates. And these were much, much higher than in chemotherapy alone. And the secondary endpoint was something called major pathological response, which I think we’re going to have to get used to. This is less than 10% of tumor, viable tumor left in the specimen. And this is major pathological response.

And those two endpoints are thought to be surrogate markers for outcome. And we’ll see whether, how, how closely they follow outcome with regards overall survival. But that’s the hope. And some of these patients, in fact a majority of patients on the chemotherapy, immunotherapy arm, received complete pathological responses, which has really been unheard of in lung cancer previously.

So, the key point of the whole, I suppose the session was looking at immunotherapy and targeted therapies moving into cure for lung cancer, and really I’m pleased to see really the advances we’ve made in advanced lung cancer are now moving into curative disease.