Lung Cancer IO – hi ho


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Mary O'Brien1
1Royal Marsden NHS Hospital

Abstract

Lung cancer is reaping the rewards of 30 years of research by scientists and clinicians in both academic fields and the pharmaceutical industry. Immunotherapy (IO) is developing in a parallel fashion to targeted therapied. IO appears to be active in the tumours with a large number of non specific mutations caused by smoking without a unique driver mutations. Targeted therapies are changing and prolonging the lives of patients with tumours driven by a unique driver tumour mutation who are either light or never smokers. We see and welcome the progress in both group and recognise there is overlap. The development started with replacement of toxic standard second line treatments like docetaxel by a more active drug - pembrolizumab, nivolumab or atezolizumab. Through this it became obvious that tumour expression of PDL1 was and is a reasonable biomarker to select those tumours with the highest chance of responding. This has now been improved upon by documentation of the tumour mutation burden (TMB). Moving this forward to patients with tumours with high expression of PDL1, in the first line setting, IO without chemotherapy, has produced un precedented median survival of 30 months in patients with stage 4 lung cancer, compared to a historic standard of around 12-14 months (KEYNOTE 024). Moving to earlier stage disease, where cure becomes the aim, PACIFIC using durvalumab has given us the first signal. In the UK we are part of the PEARLS adjuvant study where the use of IO after curative surgery will help us understand the role of the presence of the primary tumour as a source of antigens and TIL cells. So hi ho hi ho, its of to work we go.