Dr. Langer on the Current State of Immunotherapy in Advanced NSCLC

Corey J. Langer, MD, director, Thoracic Oncology, Abramson Cancer Center, professor of medicine, Perelman School of Medicine, University of Pennsylvania, discusses the current state of immunotherapy in advanced non—small cell lung cancer (NSCLC).

Immunotherapy has had a significant impact on patients with advanced NSCLC, but the benefit has not been quite as striking as the targeted therapies in patients with oncogene-driven disease, Langer says. With targeted therapy, the presence of a mutation indicates whether patients will have a response or not. Although high PD-L1 expression means there is a higher likelihood of response to PD-1/PD-L1 inhibitors, it does not guarantee a response.

Even in the PD-L1—high group, response rates to single-agent pembrolizumab (Keytruda) are at best 45% to 50%, whereas targeted therapies are inducing 70% response rates. Still, data from the phase III KEYNOTE-024 and KEYNOTE-042 trials have shown a clear survival advantage with pembrolizumab monotherapy over standard chemotherapy. The big question moving forward is if chemoimmunotherapy can improve survival compared with single-agent immunotherapy. Notably, an immunohistochemistry test is all that’s needed to detect PD-L1 status—next-generation sequencing is not needed, says Langer.