Interview: “These findings will change the standard-of-care”
Interview: Barbara Melosky, MD, FRCPC, University of British Columbia and British Columbia Cancer Agency, Vancouver, Canada
Will findings presented here at ASCO change the future of NSCLC therapy? This year’s ASCO Congress was very interesting. The findings will definitely change the standard-of-care in non–small-cell and small-cell carcinoma. Immune checkpoint inhibitors are the biggest news at this year’s ASCO Congress. They are showing survival advantages in small-cell cancer, and advantages have also been proven in squamous and non-squamous NSCLC in the second line. This is going to change the landscape and the standard-of-care, especially in the second-line setting, in both squamous and non-squamous NSCLC. Nivolumab has now been accepted by the FDA for the treatment of squamous cell carcinoma in the second-line setting.
Which molecular targets deserve the greatest attention at present? There are many molecular targets and many ways to define molecular targets. We learnt that RET is an interesting target to look at; we learnt that new drugs are available for ALK; also, EGFR continues to be an extremely important issue with the emergence of third-generation EGFR inhibitors. Immunotherapy as a sort of targeted therapy against the immune system is also emerging as a major player in NSCLC and in SCC.
Should lung cancer in women be considered a “different disease”? Lung cancer in women is an extremely important issue. We used to think that it was a different disease. I think what we are learning is that it is a different disease molecularly, because of issues like smoking. If we thus were to equalise patients for some of those other issues like smoking, we might find that we should treat male and female patients alike.
What potential promises and pitfalls are currently associated with immune checkpoint blockade in cancer treatment? The biggest pitfall is the PD-1 or PD-L1 biomarker expression. One has to face questions as to which kit one should use, whether to assess the expression in the T cells or in the tissue or in the stroma, and which cut-off percentage to use – 1, greater than 5, greater than 10, or none? Therefore, the biggest pitfalls are the application of biomarkers, and of course the cost.