Dr. Patel on Novel Agents for Patients With NSCLC

Sandip P. Patel, MD, medical oncologist, assistant professor of medicine, University of California, San Diego, discusses novel agents for the treatment of patients with non—small cell lung cancer (NSCLC).

The majority of agents that are being investigated in the post—PD-1 setting will lead to novel immunologic approaches, says Patel. These are drugs that target the IDO pathway. Although, there have been questions in light of the recent negative melanoma data with epacadostat and pembrolizumab (Keytruda). There are a variety of other novel agents such as NKTR-214 which is an IL-2 immuno-conjugate, CSF1R, and OX40. These immunologically targeted agents show preliminary signals of efficacy, states Patel. It remains to be seen if these agents induce durable responses.

Resistance comes in 2 forms in the post—PD-1 setting. There are patients who have primary resistance to PD-1–directed strategies as a result of "cold" tumor environments. These patients may benefit from vaccination strategies such as tumor infiltrating lymphocyte therapies, this and other novel approaches can make "cold" tumors "hot." Patients who have adaptive resistance may benefit from strategies that upregulate interferon gamma and increase antigen presentation. It’s very likely that in the post–PD-1 setting, there are at least 2 different pathways of resistance mechanisms that will require novel agents, concludes Patel.