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The Rationale for Initiating Therapy with an Immuno-Oncology Drug

Andrew L. Pecora, MD, provides insight regarding biomarkers and whether to incorporate an immunologic approach.

When deciding whether to recommend an immunotherapy agent, it is important to ensure that the drug is approved for the specific indication. In addition, because an immunotherapy agent can take several weeks to have an effect, it is important to consider the pace of the patient’s disease progression, says Andrew L. Pecora, MD.
Biomarkers are an essential part of decision making, although some biomarkers have not been found to be absolutely predictive. The greater number of mutations a cancer has, however, the greater the likelihood that an immuno-oncology drug will work, states Pecora.
About half of patients respond to immuno-oncology drugs when they are given in combination or sequentially, notes Pecora, and fewer when the drugs are given alone. There is some variability among the diagnostic tests, states Pecora, and there are many potential explanations. At times, the tissue sample is not representative of the tumor. Also, the microenvironment of the tumor is not static. The tumor could be leaving an inflammatory state where there would be a lot of PD-1 expression, for example, and going to a noninflammatory state. There are still many unanswered questions in terms of which biomarkers are the most important in which instances, adds Pecora.
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