Integrating Novel Personalized Therapy Into NSCLC Treatment

During an NAMCP 2016 Fall Managed Care Forum presentation, Joel W Neal, MD, PhD, discussed how to integrate novel personalized therapies, such as immunotherapy, into non-small cell lung cancer (NSCLC) treatment plans to optimize outcomes. 

Dr Neal opened his presentation by noting that lung cancer is the leading cause of cancer-related mortality in the United States, and that lung cancer accounts for more deaths than breast, prostate, and colorectal cancers combined. Dr Neal also explained that characteristically, lung cancer is heterogeneous with varying stage distribution at time of diagnosis, a preventative cause (smoking), and a varying histology and molecular profile. However, he stated that annually, 25,000 to 30,000 patients diagnosed with lung cancer have never smoked. 

During the presentation, he discussed how over the past 2 decades there have been paradigm shifts in terms of advances in NSCLC treatment. Among these shifts is the emphasized importance of determining histology—distinguishing between squamous vs nonsquamous—to select the proper therapy. Additional advances in the treatment of NSCLC include, the introduction of maintenance and second-line chemotherapy, anti-angiogenic therapy, treatments targeting oncogenic driver mutations, and lastly, the emergence of immunotherapy as a practical first-line treatment option. 

Dr Neal explained that patients with the PD-L1 biomarker can be targeted for immunotherapy treatments, with drugs like Keytruda (pembrolizumab; Merck) and Opdivo (nivolumab; Bristol-Myers Squibb), as first-line treatments instead of taking the more debilitating option—chemotherapy. He presented evidence from clinical trials showing that both Opdivo and Keytruda performed better than docetaxel chemotherapy. Dr Neal also discussed the immunotherapy Tecentriq (atezolizumab; Roche), which also increased overall survival when compared to docetaxel. Tecentriq is approved to treat NSCLC patients whose disease has progressed during or after platinum-based chemotherapy. 

“Immunotherapy is now a reality in the treatment of advanced NSCLC,” Dr Neal said. However, he noted that because toxicity patterns are unique for immunotherapy, with grade 3 and above toxicities occurring in less than 5% of patients, “Education at all levels (MD, PA/NP, nurses, patients, and caregivers) about the nature of immune-related adverse events is necessary.” —David Costill