Module 2: Driving forwards with immunotherapy in NSCLC – applications for clinical practice - ESMO-IO 2018
Learning Objectives Introduction

Introduction

Watch an internationally renowned faculty discuss the changing treatment paradigms in advanced NSCLC, including the current and future role of immunotherapy.

Dr. Maria Chiara Garassino and Dr. Maurice Pérol, discuss recent developments in clinical research and how these can be translated into clinical practice. Professor Enriqueta Felip and Professor Sanjay Popat (Chair) then provide insight on the future management of patients with advanced NSCLC using clinical case studies.

The information in this activity is intended for oncologists, nurses, and other healthcare professionals involved in the treatment of patients with lung cancer.

This ACCME-accredited touchSATELLITE SYMPOSIUM was recorded live during the ESMO Immuno-Oncology Congress in December 2018. The live voting content is no longer active for this symposium.

Learning objectives

After watching this touchSATELLITE SYMPOSIUM, you should:

1 AMA PRA Category 1 Credits™
Date of original release: March 7, 2019
Date credits expire: March 7, 2020 

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touchSATELLITE SYMPOSIUM

Harnessing the power of immunotherapy in advanced non-small cell lung cancer:
how do we navigate the increasingly complex patient pathway without an oncogenic driver?

1 AMA PRA Category 1 Credits™
Date of original release: March 7, 2019
Date credits expire: March 7, 2020 

Module 2: Driving forwards with immunotherapy in NSCLC – applications for clinical practice

Dr. Maurice Pérol, MD discusses how the latest clinical data for advanced NSCLC can be translated in the clinic. He reviews patient selection, and examines the clinical relevance of PD-L1 and tumour mutational burden as biomarkers. He also highlights clinical challenges around management of the increased toxicity observed with immunotherapy-chemotherapy combination treatment.

Key Learnings

Please test your knowledge about the information presented. The following questions will need to be completed to progress.

Q1. A number of trials have investigated anti-PD-L1 monotherapy and the cut-off for PD-L1 expression in patients with metastatic NSCLC without an oncogenic driver. Which of the following statements is true?

Patients with a PD-L1 expression of ≥ 50% had a significantly longer PFS and OS
Patients with a PD-L1 expression of < 1% had a significantly longer PFS and OS
A PD-L1 expression of ≥ 1% was not associated with a significantly longer PFS than chemotherapy
Outcomes and response to anti-PD-L1 monotherapy for patients with metastatic NSCLC are not driven by PD-1 expression

The KEYNOTE-024 trial investigated the use of pembrolizumab in patients with advanced NSCLC with PD-L1 expression of ≥50% of tumour cells and demonstrated anti-PD-L1 monotherapy was associated with significantly longer PFS and OS.4,5
The KEYNOTE-042 trial included patients with advanced NSCLC with PD-L1 expression of ≥1% of tumour cells, and also studied the subgroup of patients with advanced NSCLC with PD-L1 expression of ≥50%.6
In KEYNOTE-024 the median PFS was 10.3 months (95% CI, 6.7 to not reached) in the pembrolizumab group vs. 6.0 months (95% CI, 4.2–6.2) in the chemotherapy group (HR for disease progression or death, 0.50; 95% CI, 0.37–0.68; p<0.001). The estimated rate of OS at 6 months was 80.2% in the pembrolizumab group vs. 72.4% in the chemotherapy group (HR for death, 0.60; 95% CI, 0.41–0.89; p=0.005).5
In KEYNOTE-042 after 12.8 months median follow-up OS in patients with PD-L1 ≥50% was 20 months vs. 12.2 months in the chemotherapy group (HR 0.69; 95% CI, 0.56–0.85; p=0.003).4

The KEYNOTE-024 and KEYNOTE-042 trials did not investigate the comparison of pembrolizumab to chemotherapy in PD-L1<1% NSCLC.6 The CheckMate-026 study and the MYSTIC trial did not include PD-L1 negative tumours.7,8
The CheckMate-026 study and the MYSTIC trial did not include PD-L1 negative tumours.7,8

The KEYNOTE-042 trial investigated the use of pembrolizumab in patients with advanced NSCLC with PD-L1 expression of ≥1% of tumour cells and did not demonstrate that anti-PD-L1 monotherapy was associated with significantly longer PFS (HR for death, 1.07; 95%CI, 0.94-1.21).6

In both first- and second-line trials comparing anti-PD(L)-1 to chemotherapy, there is a correlation between the magnitude of OS benefit with the level of PD-L1 expression.4,6

Next Question

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REFERENCES