There Is Room for Improvement in Immunotherapy: Dr Siow Ming Lee

A large session at the 2024 World Conference on Lung Cancer featured speakers from India, Canada, the US, and the UK, whose discussions tackled the current challenges and controversies associated with immunotherapy. Among this group, Siow Ming Lee, PhD, FRCP, professor of Medical Oncology, University College London, and consultant medical oncologist at University College London Hospitals, brought attention to the particular challenges faced by special patient subgroups in the lung cancer population.

His talk surveyed the considerations that are necessary for approaching patients with poor performance status, autoimmunity, prior history of transplant, and the elderly. In an interview with The American Journal of Managed Care®, Lee discussed these patient populations in more detail and pondered on the specialized care necessary in these cases. He also looked ahead toward necessary research efforts to improve immunotherapy outcomes.

This transcript has been lightly edited for clarity and length.

Transcript

What are the most critical areas of research for improving immunotherapy outcomes in special patient subgroups? Are there emerging therapies that could address these challenges?

That's a very good question. If you look at the data, in terms of the [population] number, the big problem is that these elderly, frail, poor PS [performance status] patients are a big population out there. You don't see them in a major teaching hospital; they end up in a small teaching hospital or a small district hospital.

An organ transplant is probably more specialized in a different unit, so I think I don't see as much [of them] as immunosuppressed patients, which are, you know, a lot more common. So, I think in terms of ranking poor PS, elderly, not fit for platinum doublet [patients], we are talking about the [aged] 75+ population, not the 65+ poor-performance patient. Then, when we're talking about the immunosuppressed; generally, they are already being managed in a good teaching hospital. So, I think it's easier to manage, and we certainly will engage with the MD (multi-disciplinary) role of immunotherapy to be discussed. And [these patients], normally, can be quite well controlled when they’ve got a flare.

Where do we go from here? We have made progress. Atezolizumab has now been approved in the NCCN 2024 guideline for PS 3, and the EMA [European Medicines Agency] has now approved atezolizumab—or we call it Tecentriq—for frail, poor PS patients, mainly elderly, who are unfit for standard platinum chemotherapy. I think that's really good news for our lung cancer population and should cover a big gap out there, a missing gap in terms of the role of immunotherapy.

And in terms of the other 2, I think we need to do more study. We need to study the Hanna regimen for solid organ transplant, where they use mTOR inhibitor plus pulse steroid, and see whether the EBU decides to go ahead with immunotherapy for well-controlled transplant patients. We need to do studies on that. I think that a trial is ongoing for that, and also a trial ongoing for immunosuppressive disease. The problem is that for immunosuppressive disease there are over 80-90 different types. And so, it'd be good to see Crohn [disease]—the GI [gastrointestinal] one, which is a big side effect in immunosuppressive patients—in a big, big number. And ulcerative colitis, Crohn disease, celiac, and that kind of thing. So, we need to get more data [and ask], “How do we manage them?”