Dr. Jahanzeb on Immunotherapy in Oncogene-Driven NSCLC

Mohammad Jahanzeb, MD, professor of Clinical Medicine, Hematology/Oncology, Sylvester Comprehensive Cancer Center, at University of Miami Miller School of Medicine, discusses the use of immunotherapy in patients with oncogene-driven non—small cell lung cancer (NSCLC).

Carcinogen-induced tumors caused by smoking or sunlight exposure are “ugly” tumors with a high mutational burden, says Jahanzeb. Data supports that these tumors are more immunogenic, and thus, more likely to respond to checkpoint inhibition. He adds that activated T cells are more likely to recognize these “ugly features” in a patient’s disease.

Tumors that are driven by EGFR, ALK, or more rare alterations are pristine-looking cells with essentially only 1 thing wrong with them—the mutation driving the tumor, says Jahanzeb. As such, it is more difficult for the immune system to detect and attack the disease. Thus far, data has shown that the use of immunotherapy does not seem to benefit these patients. As such, this approach should only be considered after patients have exhausted multiple lines of TKIs and chemotherapy. Immunotherapy is clearly not a first- or second-line option for this patient population, he concludes.