Dr Herbst on Notable Research Avenues for Patients With Unmutated NSCLC

Roy S. Herbst, MD, PhD, Ensign Professor of Medicine (Medical Oncology), professor, pharmacology, deputy director, Yale Cancer Center; chief, Medical Oncology, director, Center for Thoracic Cancers, Yale Cancer Center and Smilow Cancer Hospital; assistant dean, Translational Research, Yale School of Medicine, discusses ongoing, planned, and future research that is needed to improve treatment strategies for patients with unmutated non–small cell lung cancer (NSCLC).

Currently, chemoimmunotherapy is being used in a large number of patients with NSCLC, yielding notable results, including complete pathological responses and major responses, Herbst begins. However, it’s important to recognize that not all patients derive benefit from this approach, he notes. Encouragingly, the phase 3 KEYNOTE-671 trial (NCT03425643) has already demonstrated a survival advantage with pembrolizumab plus platinum-doublet chemotherapy vs placebo plus chemotherapy in patients with early-stage NSCLC. Results are awaited from additional studies to confirm these findings across different patient groups, Herbst states.

For patients who are ineligible for neoadjuvant therapy or those who undergo frontline surgery, adjuvant therapy becomes the focal point, as evidenced by outcomes in the phase 3 KEYNOTE-091 trial (NCT02504372), he continues. Overall, several studies support the use of both neoadjuvant and adjuvant therapeutic options, Herbst reports.

Ultimately, introducing immunotherapy at some point in the treatment continuum—whether before or after surgery—can be advantageous, and it’s worthwhile to pursue whenever possible, he expands. Herbst states that although his view leans toward administering immunotherapy in the neoadjuvant setting, careful patient selection is essential to ensure the timing is appropriate. Delaying surgery can be detrimental if patients do not respond to neoadjuvant therapy, potentially rendering their disease unresectable, which oncologists strive to avoid, he emphasizes.

The NSCLC management field is evolving rapidly, and ongoing trials and real-world applications continue to shed light on optimal treatment approaches, Herbst says. Herbst concludes by stating that immunotherapy’s role remains a fertile area for research and holds promise for advancing treatment strategies and improving patient outcomes.