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Professor Karapetis
The next step for immune therapy in lung cancer is in combination with chemotherapy or radiotherapy as first line treatment, according to oncologist Associate Professor Chris Karapetis.
Immune checkpoint inhibitors are listed on the PBS as second line treatments for non-small cell lung cancer (NSCLC) but the latest trials show their potential for use first line in advanced disease, Professor Karapetis, Senior Consultant Medical Oncologist at Flinders Medical Centre, Adelaide.
Speaking at the Australian Lung Cancer Conference (ALCC) 2018 in Sydney, Professor Karapetis said that following a negative result with nivolumab monotherapy in the CheckMate 26 trial and positive results with pembrolizumab monotherapy in the KEYNOTE 24 trial, combination approaches were now showing positive results in progression free survival (PFS) and overall survival.
Attention had recently focused on combinations of immune checkpoint inhibitors such as pembrolizumab and nivolumab with standard chemotherapy in patients with higher levels of PD-L1 expression, who accounted for up to 30% of patients with NSCLC.
This had led to a change in practice in Australia, and the drug was now available through special access programs for patients with high levels of PDL1 expression, Professor Karapetis said.
Other strategies included using immune checkpoint inhibitors in combination with radiotherapy, which made the tumour release more antigen for the T-cells to act on.