Brahmer Highlights Latest on Immunotherapy and Other Lung Cancer Advances

Julie R. Brahmer, MD

Experts are looking to push immunotherapy even further in the treatment landscape of lung cancer over the next few years by exploring checkpoint inhibitors in early-stage and locally advanced disease, testing immune-based therapies in small cell lung cancer (SCLC) and mesothelioma, and tweaking some of the current methods to avoid resistance.

The 5th Annual Miami Lung Cancer Conference, taking place on March 10, 2018, will cover this expanding use of immunotherapy, as well as other treatment advances in lung cancer. The conference will also include a session on head and neck cancer.

“This jam-packed, condensed day is an opportunity to get the highlights and be able to ask detailed questions during the [Medical Crossfire^® component],” said Julie R. Brahmer, MD, co-chair of the meeting. “A benefit of these Medical Crossfires is asking provocative questions.”

OncLive: Can you provide an overview of the immunotherapy session that you are moderating?

In an interview with OncLive ahead of the meeting, Brahmer, an associate professor of oncology, co-director of the Upper Aerodigestive Department, Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins Medicine, shared her most anticipated topics, including first-line immunotherapy, targeted therapies for molecularly driven tumors, and recently released guidelines for the treatment of patients with lung cancer.Brahmer: The first few hours [of the conference] will be discussing cutting-edge therapies. Dr Justin Gainor of Massachusetts General Hospital will be discussing the NCCN guidelines on the use of nivolumab (Opdivo) plus ipilimumab (Yervoy) for SCLC, as well as trials of immunotherapy in mesothelioma. With the rapidly changing treatment landscape, there are certainly a lot of questions and patient cases to discuss. There will also be a very timely discussion about maintaining patients on immunotherapy and immune-related toxicities. While rare, these side effects do have to be managed differently than the typical side effects that we see with chemotherapy. Discussing the current guidelines for the treatment of toxicities will be interesting. Recently, ASCO and NCCN have come out with guidelines that now help us treat patients who develop side effects.

What is the take-home message on your presentation on first-line immunotherapy and avoiding resistance?

You are also moderating the Mutation-Independent Therapy session. What are you looking forward to discussing in that panel?

As co-chair, what other news coming out of the meeting are you particularly excited to hear about?

We will also be discussing therapies for patients with mutation-based lung cancer. Folks will be very excited to attend this cutting-edge seminar discussing the rapidly changing treatment landscape. Now we have multiple inhibitors for patients with ALK mutations, as well as new approaches for patients with BRAF V600E lung cancer. We have been introduced to this subset of non—small cell lung cancer (NSCLC) in the past year. We are very excited to have some of the physicians who are on the forefront of changing treatments for NSCLC, SCLC, and mesothelioma. I look forward to listening to these exciting talks. Be aware that the treatment landscape is changing rapidly, and we need to assess for PD-L1 status early in order to treat patients with squamous cell histology with first-line immunotherapy, such as pembrolizumab (Keytruda). For nonsquamous cell histology, if PD-L1 is expressed, single-agent pembrolizumab is an option. Pembrolizumab plus chemotherapy is an option for those without a known PD-L1 status. We will be discussing the news release that showed that the larger phase III study in nonsquamous cell histologies combining pembrolizumab with pemetrexed and carboplatin does improve overall survival and progression-free survival.I am looking forward to discussing the general management of these patients, as well as how we think that the future landscape is going to play out. Certainly, we will touch on how antiangiogenic therapies are here to stay, as they help us both with mutation therapy and mutation-independent therapy. Dr Gilberto Lopes of the University of Miami Sylvester Comprehensive Cancer Center will be discussing global oncology and disparities in lung cancer, which will certainty be a great talk.I am trying to keep my hand on the pulse of head and neck cancer treatment, so that session will be exciting. Also, there are parts of our practice that do remain controversial, and although you do have to treat on a patient-by-patient basis, it is good to get a feel of how physicians handle different questions in the clinic. These answers can be helpful to take back into your own clinic.