Dr Ticiana Leal on Recent Advancements in Perioperative NSCLC Care

Ticiana Leal, MD, associate professor and director of the Thoracic Medical Oncology Program in the Department of Hematology and Medical Oncology at Emory University School of Medicine and board-certified medical oncologist at Winship Cancer Institute, spoke to the latest advances in perioperative non–small cell lung cancer treatment and how recent trials have impacted standards of care.

Transcript

What are the most recent advancements in perioperative therapy for NSCLC?

There have been significant advances in the perioperative setting for patients with early-stage non–small cell lung cancer.

We've seen several approvals of therapies in the perioperative space with chemoimmunotherapy, with the approval of KEYNOTE-671 [NCT03425643; pembrolizumab with chemotherapy], and then most recently, we've seen the approval approval of the AEGEAN [NCT03800134; durvalumab with chemotherapy] regimen. In addition, we also previously saw the approval of neoadjuvant chemoimmunotherapy with CheckMate 816 [NCT0299852; nivolumab with chemotherapy]. And then we also have adjuvant strategies with approvals of IMpower-010 [NCT02486718; atezolizumab], and then KEYNOTE-091 [NCT02504372; pembrolizumab].

In addition, we also have approvals of targeted therapy in the adjuvant space, we saw approval of agents with the ADAURA trial [NCT02511106; osimertinib] as well as the ALINA trial [NCT03456076; alectinib].

How have recent clinical trials influenced the standard of care for perioperative therapy in NSCLC?

These have really changed the way that we treat patients with early-stage non–small cell lung cancer, and certainly that has been a significant gain for patients as we try to optimize treatment strategies for patients with early-stage non–small cell lung cancer, where the goal here really is a cure.

With the perioperative strategies, utilizing chemoimmunotherapy pre-op as well as post-op, we've seen improvement in event-free survival. We've seen improvement in path-CR [pathological complete response], and then in the case of KEYNOTE-671 with perioperative chemoimmunotherapy with pembrolizumab, we've seen improvement in overall survival. In addition, we saw improvement in event-free survival and path-CR with a neoadjuvant approach with CheckMate 816.

Certainly, these have definitely changed the way that we treat. I think it's very important to establish a workflow in a multidisciplinary fashion where patients can have access to all of the different specialists that will be involved in making these really important treatment decisions together with the patients.

What is the current role of immunotherapy in the perioperative setting for NSCLC?

I think based on the results of these major trials that we've briefly touched upon, it's really important to highlight that really it's the role of chemoimmunotherapy in a lot of these trials. When we think about the best outcomes that we've seen in these trials, it really is the combination of chemotherapy with immunotherapy, either in the neoadjuvant or in the perioperative setting.

I think for patients that don't receive perioperative treatment options, there is still a very important role for immunotherapy in the adjuvant setting, with approvals of atezolizumab, as well as KEYNOTE-091 with pembrolizumab for patients in the adjuvant setting.