Potential Upfront and Maintenance Strategies in NSCLC

Transcript:Martin Reck, MD, PhD: Chemotherapy has improved in the treatment of our patients. In particular, when we treat our patients with adenocarcinoma, we have identified new treatment lines. One of these lines is the use of maintenance strategies. And, in principle, we have two options. Number one is the continuation of pemetrexed after first-line chemotherapy with a pemetrexed-based platinum regimen. And, the other one is the use of bevacizumab as a continuation maintenance after first-line combination with a platinum-based chemotherapy plus bevacizumab. I would use a maintenance treatment in patients who had a response or who had at least some benefit from the first-line chemotherapy. In that group of patients, we have seen that we may induce maintenance of the response by the use of maintenance therapies.

Anders Mellemgaard, MD: There have been a couple of trials looking at the addition of maintenance therapy after first-line therapy. And, I think, that at this point in time, pemetrexed appears to be the best treatment to choose for maintenance. Previously, also erlotinib has been used. But, now when most patients are being tested up front for EGFR-mutation status, we will know which patients have a mutation and which patients don’t. And, if a patient does not have an EGFR mutation, erlotinib is probably not a good choice for maintenance therapy. So, the best choice here is pemetrexed.

Sanjay Popat, PhD: The use of immunotherapy upfront is incredibly promising. We’ve got very good early signals that this may be appropriate for a small population of patients. And, for that population of patients, it may be significant. We have evidence from phase 1 studies from cohort expansion, both with compounds such as nivolumab and pembrolizumab, specifically the KEYNOTE-001 trial, demonstrating activity of pembrolizumab in patients who were untreated with expression of PD-L1, particularly the high expression of PD-L1 at the 50% threshold or more.

At the ESMO 2016 meeting, we’ll hear the results of the KEYNOTE-024 study in which patients with high-expressing PD-L1 status over the 50% threshold are randomized to platinum-doublet chemotherapy compared to pembrolizumab. Those outcomes are currently in the press release and demonstrate a superiority for pembrolizumab compared to platinum-doublet chemotherapy.

Transcript Edited for Clarity