The Future of Immunotherapy in NSCLC

Luis E. Raez, MD: Atezolizumab has the advantage that maybe because it’s given every 3 weeks, it’s a little bit easier than every 2. These agents are great. Patients are on immunotherapy for a long time. I have patients who are on immunotherapy now for 3 years. And sometimes if you’re going to be on it for 3 years, it’s more convenient to come every 3 weeks for treatment instead of 2 weeks. I have found that some patients prefer that. We are also a center of reference for lung cancer, so we get patients that live far. And certainly, for them, that difference between the 2- or 3-week schedule can make a big difference in the choice of agents for them.

The other benefit is that the other agent given every 2 weeks is pembrolizumab. But it requires that you test positive. So, that is why another advantage of atezolizumab is that don’t require positivity for the PD-1, PD-L1 to be given. But there are no other major differences yet that we have found between these agents.

Immunotherapy is very exciting for us. There are a lot of things that are going to come. First of all, we only have 3 agents approved, but at least 3 or 4 more are coming. We have good data in phase II and ongoing phase III studies. Second, these agents are moving to the front line. Another example is pembrolizumab is already approved for frontline treatment. So, there are other immunotherapy agents that are trying to get to the frontline setting. For example, we are doing a study with atezolizumab for frontline therapy for new patients. And third, the other opportunity is the combination of immunotherapy, particularly the agents among themselves. For example, nivolumab/ipilimumab is happening now in melanoma. It’s pretty much becoming standard of care to give these agents together. We are going to learn some of these experiences in lung cancer. And the fourth exciting area is a possibility to combining chemotherapy with immunotherapy in frontline therapy. So, that’s why all of these opportunities are available. There are tons of clinical trials trying to prove or test all of these post potential indications, and it has something very exciting for us and for our patients.