Dr. Goldberg on Immune/Targeted Therapy Combos in Oncogene-Driven Lung Cancer

Sarah B. Goldberg, MD, MPH, associate professor of internal medicine, Yale School of Medicine and Yale Cancer Center, discusses the combination of immunotherapy and targeted therapy for the treatment of patients with oncogene-driven lung cancer.

Many patients who have oncogene-driven cancers, such as EGFR or ALK-rearranged lung cancers, benefit from targeted therapies; however, resistance eventually develops. Additionally, another challenge is that immunotherapy does not tend to work well on its own. This patient population is often resistant to immunotherapies. Therefore, there has been an effort to combine immunotherapies with targeted therapies for those patients. There have been various studies that have shown several different issues with this approach, one of which is toxicity.

For example, 1 trial examined the effects of combining osimertinib (Tagrisso) with durvalumab (Imfinzi). That trial showed high rates of pneumonitis and, as such, that arm of the trial was stopped early, according to Goldberg. For patients with ALK rearrangements, studies have shown combining immunotherapy with targeted therapy can lead to elevated liver function tests and other toxicities. Therefore, there is a lot of caution in this area; no new trials are being developed due to toxicity, explains Goldberg. Beyond the issue of toxicity, there is no clear benefit to combining these agents, says Goldberg. To date, there has not been a strong signal observed in terms of efficacy, she concludes.