Author: Andrew Ciupek, PhD, Senior Manager of Clinical Research, GO2 for Lung Cancer

The 2021 World Conference on Lung Cancer (WCLC) saw several research presentations that helped increase our understanding of immunotherapy as a treatment for people with lung cancer and how we might better be able to use it to help more people. Here are some of the key takeaways of recent advancements in the immunotherapy space.

Exploring the Effectiveness of Immunotherapy in Different Types of People with Lung Cancer

Several presentations at the conference focused on finding out how effective immunotherapy was at treating different types of people with lung cancer.

  • Data from the IMPOWER 010 trial showed that the immunotherapy Tecentriq (atezolizumab) was a beneficial treatment for early-stage patients at reducing the chances of their cancer coming back after surgery, regardless of the type of surgery they had received. Based on this data, Tecentriq was approved by the FDA as an adjuvant therapy (given after surgery) on October 15, 2021 for stage II-IIIA non-small cell lung cancer (NSCLC) that has PD-L1 levels greater than 1%. This is the first immunotherapy approved for people with early-stage lung cancer.
  • Data from the Checkmate 9LA study suggested that first treatment with the immunotherapies Opdivo (nivolumab) and Yervoy (ipilimumab) together with chemotherapy had similar effectiveness in lung cancer that had spread to the brain as in lung cancer that had not. Additionally, the ATEZO-Brain study using the immunotherapy Tecentriq (atezolizumab) with chemotherapy as a first treatment indicated that immunotherapy can be safely used to treat lung cancer with brain metastasis, even when they have not been locally treated (such as with radiation) if they are not causing symptoms.
  • Data was presented from a trial using Keytruda (pembrolizumab) and chemotherapy to treat lung cancer that had EGFR or ALK mutations and had stopped responding to previous targeted therapies. Although targeted therapy is a more effective first treatment than immunotherapy when these mutations are present in lung cancer, results from this trial suggested that the immunotherapy combination may be beneficial as a second treatment after targeted therapy is no longer working for certain patients with EGFR mutations but not those with ALK mutations. Immunotherapy as a treatment option after targeted therapy may be a good option when certain mutations are present in lung cancer but not others.
Using Combination Treatments to Increase the Effectiveness of Immunotherapy for More People

Several researchers at the conference presented work looking at new ways of giving immunotherapy together with other therapies to increase its effectiveness.

  • The POSEIDON trial showed that giving two different immunotherapies, Imfinzi (durvalumab) and tremelimumab, along with chemotherapy was a more effective first treatment than chemotherapy by itself.
  • More than one trial presented was focused on using immunotherapy combinations to treat lung cancer that was no longer responding to initial immunotherapy treatment. Data was presented showing that a combination of Opdivo (nivolumab), Yervoy (ipilimumab), and nintedanib had promising results in lung cancer that was not responding to prior immunotherapy and that adding the drug Avastin (bevacizumab) to the immunotherapy Tecentriq (atezolizumab) may be effective when lung cancer is no longer responding to Tecentriq.
  • We also saw promising data presented on several new immunotherapy combinations being used mainly in China as first treatments for advanced lung cancer, including: camrelizumab with apatinib and both sugemalimab (in the GEMSTONE-302 trial) and toripalimab (in the CHOICE-01 trial), which were given with chemotherapy.
New Biomarkers and Ways of Determining How People Might Respond to Immunotherapy

Although immunotherapy works well for some patients, other patients do not respond as well to it. Currently, looking at PD-L1 levels in a lung cancer is helpful when determining which patients may respond (higher PD-L1 levels may indicate more benefit) but this does not always perfectly predict response. There were several presentations at WCLC this year that looked at other, new biomarkers that could be used to help us better determine how different people with lung cancer would respond to immunotherapy.

  • Several new biomarkers to predict immunotherapy response were examined including the presence of certain mutations and the number and type of immune cells present with lung cancer – showing that we are getting more sophisticated predictive markers over time.
  • Several biomarkers that were discussed were able to be measured from blood samples which indicates that blood tests may use a useful tool for predicting immunotherapy response in the future.
  • In addition to biomarkers for immunotherapy for advanced lung cancer, we also saw two presentations on potential biomarkers to predict response to neo-adjuvant immunotherapy (given before surgery for early-stage lung cancer).
  • Two studies looked at past data from two different cancer centers to see if developing immune-related side effects from immunotherapy may predict a better immunotherapy response. The studies showed conflicting results meaning we need more research to find the answer to this question.
  • A study also showed that detecting certain immune cells called CD8-Positive T Cells in the blood may be able to predict patients that have certain side effects from immunotherapy.