Video
CASPIAN: Long-Term Follow-up Data and Potential Predictors for Treatment Outcomes
Author(s):
Expert oncologists discuss long-term data updates from the CASPIAN trial and the associated implications on clinical practice.
Transcript:
Taofeek K. Owonikoko, MD, PhD: Dr Chiang, we’ve heard about the tail of the curve with the addition of immunotherapy to chemotherapy. Can you share some of the recent updates in terms of long-term outcomes for some of the trials that we’ve now recognized as pivotal trials specifically? We had 3-year overall survival [OS] data from the CASPIAN trial. We’ve not had similar readouts from the IMpower trial, but we did have the 24 [month] readout from the IMpower133 trial. What do you think we should take away from this…in the long-term overall follow-up from these studies?
Anne Chiang, MD, PhD: I love showing my patients the tail of the curve for the CASPIAN trial. I have a copy I show to them because it’s really important that they know they could [still be alive] in 3 years. Even if they have disease that spread to the brain, there’s an outlook there, obviously; we’d love for that to be more of the population. But the fact is we’re looking at 3 years, the fact is that the CASPIAN trial showed us that you can triple the survival there from 6% to 18%. And we’re working on clinical trials to try to improve that even more. I think that’s just such an important message to give them.
Taofeek K. Owonikoko, MD, PhD: And with this, do you have any clinical or perhaps some sort of biomarker that could help predict who is going to be in that tail of the curve? When you talk to the patient, are you able to assure them that based on this or that, that they are likely to be in that tail rather than that initial cliff that a lot of our patients unfortunately experience?
Anne Chiang, MD, PhD: I wish I had that crystal ball; I don’t have that power. But I think that we can tell them that we’re really working on it. There are data, the more and more tissue that we get, we can start to look at our long-term responders, our long-term survivors, and look to see what characteristics they have. And some things that we have looked at are, for example, if they have… well, first of all, the patients who do well, are the ones who continue to do well. And we already had that concept of platinum sensitivity before, where if your disease after you finish your chemotherapy, it’s more than 6 months before you have recurrent disease, then your outlook is better than if you recurred in 3 months. So [we can tell] those patients [it’s great] if you have a better response to begin with, if that response lasts for a longer period of time. Those are the characteristics that in some studies have characterized long- term survivors, patients who have liver mets [metastases]; one study showed a worse prognosis than patients who didn’t. Then again, we’re starting to look at some of those markers like PD-L1, [which includes] very few patients…. In one study, CheckMate 032, there were probably 10% of patients who were positive for PD-L1 in some way. In the KEYNOTE trial, it was somewhere, if you change the definition to include the immune cells, then you could get up to around 30%. [In] at least one study if [there was] some PD-L1 expression, that may be correlated with those patients who are long-term survivors, [those who] seem to have a little more PD-L1 expression, but we’re still learning about that.
Transcript edited for clarity.
