Jack West, MD, joins the podcast to discuss the immunotherapy in the treatment of lung cancer. Dr. West is an associate clinical professor in medical oncology at City of Hope Comprehensive Cancer Center in Duarte, Calif., and a thought leader in thoracic oncology. Dr. West and Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, discuss assays, liquid biopsy, and review a recent case in part two of their interview.
Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, reminds us that even when just “covering” a patient for another physician, you could be in for some difficult discussions.
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This Week in Oncology
Atezolizumab bests chemo in NSCLC patients with high PD-L1 expression
by Jennifer Smith
Atezolizumab monotherapy can improve overall survival in treatment-naive patients with stage IV non-small cell lung cancer and high PD-L1 expression according to the results of a phase 3 trial presented at the 2019 annual meeting of the Society for Immunotherapy of Cancer.
Assays
- Important to rapidly test for PDL1, EGFR and ALK status and have all results before committing to first-line therapy.
- PDL1 testing results often take 24 hours, while EGFR and ALK results can take several weeks; committing to immunotherapy without knowing the status of molecular drivers is not ideal.
Liquid biopsy
- Measures DNA from tumor cells circulating in the blood.
- Testing takes about a week.
- A positive result can be trusted.
- A negative result cannot be trusted, given low sensitivity, especially in patients with low tumor burden.
Adverse effects of immunotherapy
- Striking variability in toxicity profiles among patients.
- Although overall better tolerated than chemotherapy, the “unknown” aspect of immunotherapy toxicities may be anxiety provoking for patients.
- Fatigue, rash, and thyroid abnormalities are most commonly seen.
- However, there is a broad array of toxicities that oncologists may not be familiar with, necessitating a multidisciplinary approach.
Case discussion
- An otherwise healthy, middle-aged woman presents with two lung nodules: a 1.4 cm lesion in the left upper lobe, and a 3.1 cm lesion in the left lower lobe.
- Both are biopsy proven to be non–small cell adenocarcinoma. Both lesions are excised with clear margins. There is no lymph node, vascular, or pleural invasion.
- In this case, it makes sense to view these as two independent cancers.
- Unclear if the chance of recurrence is increased based on the presence of two, less than 4 cm lesions with negative prognostic features and adequate excision with clear margins.
- The anticipated benefit of adjuvant chemotherapy must be weighed against toxicities, and the individual patient’s ability to tolerate chemotherapy must be considered.
Resources
Dr. West’s cancer education website for patients and caregivers: cancergrace.org
Show notes by Sugandha Landy, MD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.
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Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Podcast Participants
David Henry, MD 