Statement: “Select the patients who will be able to benefit”
At this ASCO Congress, the biggest news in the field of NSCLC was the effects of the checkpoint inhibitors in the treatment of this disease. This applies especially to the results of the CheckMate 057 trial. The PD-1 inhibitor nivolumab is one of the first checkpoint inhibitors to be approved in lung cancer; it was approved in the United States for the treatment of squamous NSCLC early in 2015.
CheckMate 057 assessed nivolumab in the non-squamous patient group. This trial was conducted in the second-line setting. The study revealed a significant survival benefit of nivolumab as compared to standard second-line chemotherapy with docetaxel. Nivolumab was well tolerated. These results are certainly going to change our practice.
One interesting facet of the study consisted of the evaluation of PD-L1 expression by means of immunohistochemistry. If this assay is validated, it will be a very important predictive tool. The study showed that nivolumab-treated patients whose tumours highly express PD-L1 had a significant survival advantage. These are patients in the second line whose median survival exceeds 19 months, compared to only 8 months for chemotherapy. In contrast, the outcomes of nivolumab-treated patients whose tumours did not express PD-L1 were identical to those of chemotherapy-treated patients.
One of the aspects we do not address to a sufficient degree, but which is certainly going to be of concern, is that many of these novel agents are very expensive. Therefore, being able to select the patients who will be able to benefit from the treatment is advantageous for the patients themselves, because they do not receive therapies that do not work for them. On the other hand, there is an advantage for society at large, as money will not be spent on futile treatments.