Immunotherapy has demonstrated efficacy in lung cancer, for which there are drugs approved as second-line therapies, states Andrew L. Pecora, MD. First-line doublet chemotherapy is given for metastatic non–small cell lung cancer (NSCLC). If the patient has an ALK or EGFR mutation, treatment would include a targeted therapy.
Chemotherapy is never curative in metastatic NSCLC, says Pecora. An anti-PD-1 agent can be given once chemotherapy fails, although there is some debate regarding whether to give immuno-oncology agents up front in order to stimulate the immune system earlier in the disease process.
When nivolumab is added to ipilimumab, there is an increase in the rate of response, adds Pecora. The combination has the potential to improve survival. One issue with combining a PD-1 inhibitor with an anti-CTLA4 agent is toxicity. Once the immune system is stimulated, it can produce adverse effects that must be addressed quickly, says Pecora. Using these agents at a lower dose and/or altering the sequencing could, in theory, help reduce these effects.