Non-Small Cell Lung Cancer: KOL Insight [2018]

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Publication Date:
September 2018
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What are the next key opportunities for growth of IOs in NSCLC?

The growth of IO in NSCLC continues unabated. As Merck & Co.'s Keytruda becomes increasingly dominant in the first-line metastatic setting, will it be possible for BMS’ Opdivo/Yervoy or Roche’s Tecentriq to capture a segment of this lucrative market? Furthermore, with AstraZeneca’s Imfinzi setting a new standard of care for stage III unresectable NSCLC, what further opportunities exist for IO in early-stage disease? Could adjuvant or neoadjuvant use shift the treatment paradigm towards a potential cure for some patients? Roche’s Alecensa and AstraZeneca’s Tagrisso have quickly risen to prominence in ALK- and EGFR-mutation driven cancers; could this open up new opportunities in later treatment lines for additional targeted therapies such as Pfizer’s lorlatinib or Takeda’s Alunbrig and could IO-based combinations also play a role?

In this report, you’ll learn about these issues, plus many more, as 12 of the world’s leading KOLs offer candid insights on 11 marketed therapies and seven pipeline drugs. 

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Top takeaways

  • Imfinzi is approved in the US for stage III unresectable NSCLC that has not progressed after chemoradiotherapy. How well has it been accepted and is this situation likely to be emulated in the EU?
  • A number of clinical trials are currently evaluating PD-1/L1 inhibitors in non-metastatic settings. How do KOLs view the rationale for using these drugs earlier and could this improve treatment outcomes for patients?
  • Immunotherapy has transformed the front-line treatment of NSCLC. How is first-line treatment anticipated to evolve, and what will inform treatment decisions, in the non-driver mutation space?
  • Data from the KEYNOTE-189 trial have secured FDA approval for Keytruda in combination with pemetrexed and platinum chemotherapy in metastatic nonsquamousNSCLC. How do KOLs interpret these data and how widely will this regimen be adopted?
  • An OS benefit was reported for Keytruda plus chemotherapy in the KEYNOTE-407 trial in the first-line squamous metastatic setting. Could KEYNOTE-407 do for squamous what KEYNOTE-189 has done for nonsquamous NSCLC?
  • How do KOLs view the potential for BMS’ Opdivo plus Yervoy to succeed as a first-line treatment for metastatic NSCLC? What will be the key determinants of success?
  • Tecentriq in combination with Avastin and chemotherapy is still pending approval in the US. How do KOLs interpret findings from the Phase III IMpower150 trial on which the FDA application was based, and how do they view the potential for this regimen to succeed?
  • Novartis’ anti- interleukin-1β monoclonal antibody canakinumab represents a novel approach to the treatment of NSCLC. Could this mechanism of action constitute a viable approach to NSCLC treatment or prophylaxis?
  • Roche’s Alecensa and AstraZeneca’s Tagrisso have quickly risen to prominence in ALK- and EGFR-mutation driven cancers. Could this open up new opportunities in later treatment lines for additional targeted therapies such as Pfizer’s lorlatinib or Takeda’s Alunbrig and could IO-based combinations also play a role?
  • Biomarker testing and patient selection are set to become more sophisticated. How will they continue to develop and impact the NSCLC treatment algorithm?
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“I think the majority of patients are going to be getting first-line immunotherapy in some form or another. The main question will be whether patients are getting it as monotherapy, in combination with a chemotherapy doublet, or a minority may be getting it with ipilimumab, or another CTLA-4 inhibitor.”
US Key Opinion Leader

“Some of the biggest changes may be in early-stage lung cancer in terms of immune therapies, either in combination or by themselves, after surgery or before, after or during radiation treatment. That may alter practice in terms of early-stage cancer, but also may decrease relapse rates leading to fewer patients with metastatic disease in the future.”
US Key Opinion Leader

Sample of therapies covered

Marketed therapies

  • Keytruda (pembrolizumab; Merck & Co.)
  • Opdivo (nivolumab; Bristol-Myers Squibb)
  • Tecentriq (atezolizumab; Roche)
  • Imfinzi (durvalumab; AstraZeneca)
  • Tagrisso (osimertinib; AstraZeneca)
  • Xalkori (crizotinib; Pfizer/Merck Group)
  • Zykadia (ceritinib; Novartis)
  • Alecensa (alectinib; Roche)
  • Alunbrig (brigatinib; Takeda)
  • Cyramza (ramucirumab; Eli Lilly)
  • Tafinlar/Mekinist(dabrafenib/trametinib; Novartis)

Phase III

  • Avelumab (Bavencio; Merck Group/Pfizer)
  • Ipilimumab (Yervoy; Bristol-Myers Squibb)
  • Cemiplimab (REGN 2810; Regeneron/Sanofi)
  • Canakinumab (Novartis)
  • Dacomitinib (PF-00299804; Pfizer/SFJ)
  • Lorlatinib (PF-06463922; Pfizer)
  • Ensartinib (X-396; Xcovery)

KOLs interviewed

KOLs from North America

  • Yanis Boumber, Assistant Professor, Department of Hematology/Oncology, Lung Cancer and Mesothelioma TRDG Member, Fox Chase Cancer Center, Philadelphia, PA
  • Paul A. Bunn, Distinguished Professor and James Dudley Chair in Lung Cancer Research, Division of Medical Oncology, University of Colorado, Denver, CO
  • Alberto A Chiappori, Senior Member of Oncology and Medicine for the Thoracic Oncology Program, Moffitt Cancer Center and Research Institute, Tampa, FL
  • Saad Khan, Assistant Professor and Medical Oncologist, Department of Internal Medicine, Southwestern Medical Center, University of Texas, Dallas, TX
  • Philip E. Lammers, Assistant Professor of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
  • Howard West, Medical Oncologist and Medical Director of the Thoracic Oncology Program, Swedish Cancer Institute, Seattle, WA

KOLs from Europe

  • Qamar Ghafoor, Consultant Clinical Oncologist and honorary lecturer at the University of Birmingham/University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  • Maciej Rotarski, Medical Oncologist, Centre d'Oncologie et de Radiothérapie du Pays Basque, Bayonne, France
  • Yvonne Summers, Consultant Medical Oncologist and Clinical Lead, University Hospital of South Manchester (UHSM), Manchester, UK
  • Marie Wislez, University Professor and Thoracic Oncologist, Sorbonne Universités/Hôpital Tenon, Paris, France
  • Anonymous German KOL, Medical Oncologist, specialist teaching hospital, Germany
  • Anonymous German KOL, Medical Oncologist, specialist teaching hospital, Germany

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