Dr. Patel on Primary and Adaptive Resistance to Immunotherapy in NSCLC

Sandip P. Patel, MD, medical oncologist, assistant professor of medicine, University of California, San Diego, discusses primary and adaptive resistance to immunotherapy in non—small cell lung cancer (NSCLC).

Resistance to anti—PD-1 strategies in NSCLC recapitulate some of the data from metastatic melanoma. Oftentimes patients who initially have a response to these strategies, but ultimately develop adaptive resistance have similar downregulation in the human leukocyte antigen and beta-2 microglobulin. These are characteristic in metastatic melanoma as well, says Patel.

However, the majority of patients with NSCLC who benefit from PD-1 inhibition have what is called primary resistance. These are patients who lack the T-cell infiltrate. For these patients, vaccination strategies and other modalities to best determine which therapeutic strategy makes the most sense to inflame an otherwise cold tumor microenvironment will be key. This is one of the biggest areas of research in cancer immunotherapy, in particular for NSCLC, concludes Patel.