Dr. Sequist on Implications of the IMpower150 Trial in Advanced Nonsquamous NSCLC

Lecia V. Sequist, MD, MPH, the Landry Family Associate Professor of Medicine at Harvard Medical School, and director, Center for Innovation in Early Cancer Detection, Massachusetts General Hospital, discusses the implications of the phase III IMpower150 trial in advanced nonsquamous non—small cell lung cancer (NSCLC).

There are several frontline regimens of chemotherapy and immunotherapy that are now FDA approved in the United States for nonsquamous NSCLC, the most recent of which is the 4-drug regimen composed of carboplatin, paclitaxel, bevacizumab (Avastin), and atezolizumab (Tecentriq). The approval was based on data from the IMpower150 study, which compared chemotherapy versus chemotherapy with immunotherapy. The trial also addressed the question of whether or not VEGF inhibition is needed.

The trial suggested that there might be an additive benefit with VEGF and immunotherapy, says Sequist. Notably, IMpower150 was the only study to include a subset of patients with driver mutations such as ALK and EGFR. The trial suggested, albeit in a small patient size, that there was a benefit to administering chemotherapy and immunotherapy in those patients. There are many interesting leads being generated from that study, adds Sequist. However, these leads need to be explored further before they can be generalized and applied to routine practice. Despite the availability of the regimen, Sequist says most practitioners are opting for 1 of the pembrolizumab (Keytruda) regimens instead because 4 drugs together can be a lot to handle.