The standard-of-care for inoperable stage III NSCLC is concurrent chemoradiotherapy. However, the role of consolidation chemotherapy remains controversial. The multi-targeted antifolate pemetrexed shows selective activity in non-squamous NSCLC.
Will findings presented here at ASCO change the future of NSCLC therapy?
Immune checkpoint inhibitors have become established as standard therapy for certain subsets of NSCLC patients. Efforts are ongoing to optimise the benefits gained through these drugs, by identification of reliable prognostic and predictive biomarkers, such as PD-L1 expression in tumour cells or infiltrating immune cells, CD8-positive tumour-infiltrating lymphocytes, smoking status, and mutation burden.
Small-cell lung cancer (SCLC) accounts for approximately 15 % of all lung cancers, and it is associated with poor outcomes. 70 % of these patients present with extensive disease. Their treatment remains a significant challenge for oncologists. The median survival in the extensive disease stage is 7 months to 9 months, and only 2 % of patients survive for 5 years
At this ASCO Congress, the biggest news in the field of NSCLC was the effects of the checkpoint inhibitors in the treatment of this disease. This applies especially to the results of the CheckMate 057 trial. The PD-1 inhibitor nivolumab is one of the first checkpoint inhibitors to be approved in lung cancer; it was approved in the United States for the treatment of squamous NSCLC early in 2015.
EGFR mutations and ALK rearrangements are well-established therapeutic targets in NSCLC, with EGFR TKIs and ALK TKIs representing the first-line standard of care for these molecular subsets of patients. However, resistance to first-generation inhibitors invariably develops, which calls for strategies to improve upon the durability of any response.
Which of the recent advances in the field of NSCLC would you deem most important from the clinical point of view?
Tumours with squamous histology account for 20 % to 30 % of cases of non–small-cell lung cancer (NSCLC). Despite this substantial proportion, only limited progress has been made in the treatment of advanced squamous-cell carcinoma (SCC) compared to non-squamous NSCLC, and thus SCC of the lung is a disease with a high unmet medical need.
As for many other oncological diseases, the management of lung cancer has undergone major changes in the last few years with the rise of targeted therapies, and more lately, of immunotherapy. These advances are reflected in the results of experimental research and clinical trials that were presented at the Annual Meeting of the American Society of Clinical Oncology that took place in Chicago, from 29th May to 2nd June, 2015.
