What Could Emerging Immunotherapy Research Mean for Lung Cancer Patients?

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Topics include: Treatment

At the recent American Society of Clinical Oncology (ASCO) meeting, lung cancer expert Dr. Alex Spira joined Patient Power to discuss developing lung cancer research, including the POPLAR study, a Phase II trial comparing the anti-PDL1 drug atezolizumab with docetaxel (Taxotere). Dr. Spira explains how the treatment landscape over the last few years has changed “dramatically” and what it could mean for lung cancer patients.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Carol Preston:

Hello everyone and welcome to Patient Power. I’m Carol Preston, and we are at ASCO this week, the American Society of Clinical Oncology, where thousands of researchers from around the globe are presenting their latest research on a variety of cancers, not the least of which is lung cancer, which so many, many people in our country and around the world have it. So joining us to explain the research that he’s been doing in the popular study is Dr. Alex Spira of Virginia Cancer Specialist. And, Dr. Spira, anything else we want to know about you in terms of your credentials?

Dr. Spira:               

So I’m a medical oncologist in Northern Virginia outside of Washington, DC. I run our research program, and I mainly see lung cancer, but I do see other kinds of patients as well.

Carol Preston:   

Let’s talk about the popular study, which you presented. You presented the latest information yesterday or this weekend at ASCO. So what exactly are you—what is it, and what are you looking at?

Dr. Spira:               

So the popular study is one of the many anti-PDL or PD1 drugs. This study was a large Phase II study, which compared atezolizumab which is the anti-PDL1 drug with docetaxel (Taxotere), which is a standard chemotherapy and in short what we found is that patients receive this drug, atezolizumab, did better. They live longer. It took them longer before they progressed. So they did very well overall, especially when you compare it with chemotherapy.

Carol Preston:   

Now is this for non-small cell, small cell?

Dr. Spira:               

It’s—so it’s being tested in many tumor types, but our particular study was looking at non-small cell lung cancer.

Carol Preston:   

And is it working for everybody or is that the vexing issue of figuring out what these biomarkers are?

Dr. Spira:               

So that’s the huge vexing issue. So what we actually found was that there was a subset of patients. The subset was about two-thirds of patients that really did benefit, and the biomarker is one of the challenges. We’re always trying to find ways not just to give the drugs to everyone to avoid toxicities and costs, but we’re trying to figure out what patients that it works in. What we found is that you sub-select those patients based upon PDL1 staining. The issue is that it’s a complex test to be done, and the data still needs to be sorted out. But what we found is that when you looked at patients with certain levels of PDL1 staining, they really benefited well compared with the chemotherapy.

Carol Preston:   

What percentage in terms of your study are benefiting?

Dr. Spira:               

So two-thirds, so at least two-thirds. Even when you compare the low group, they did not worse than chemotherapy, and that’s always a good thing as well, because the chemotherapy has a lot more side effects. But we’re just looking at patients that did better, two-thirds of patients actually did better with atezolizumab than they did with the chemotherapy.

Carol Preston:   

Now I’m sure a lot of patients would be interested in this clinical trial. And while it’s ongoing, you’re not accepting new patients at this time?

Dr. Spira:               

So this clinical trial is closed. They actually did a much larger Phase III study with four times the amount of patients. That’s also closed to accrual. But there [are] a lot of studies that are now being done, and hopefully some drugs will be approved across the indication so people can get it even without enrolling on study. But there [are] a lot of studies coming up down the pike that will hopefully allow patients to get this drug in various lines of therapy for their lung cancer.

Carol Preston:   

You know we’re talking so much about these PD1 or PDL1 inhibitors. Does this mean that chemotherapy is becoming a dinosaur?

Dr. Spira:               

So no. So many of the trials now are actually looking at combining it with chemo, because we think we can do even better. There are patients from when we’re not going to give people chemotherapy, particularly the second-line setting. It’s such a rapidly changing area that it’s really hard to know where things are going to go. We’re looking at combining these drugs with all sorts of different things, drugs, new therapies and times to see when people can really do the best. For now, chemo is still going to be the backbone of our therapy.

We’re really looking to try and improve on it by giving it with chemo because you can. So mainly it’s going to be used as a second-line treatment for now, but stay tuned because things are going to be changing over time.

Carol Preston:   

Yeah because the question I would have is the standard of care, which is still working for a lot of people it does have an impact on the DNA. That can be altered. So is there the desire to try to move away from it?

Dr. Spira:               

There is a huge desire to try to move away from it. Scientifically, we think these drugs actually work better when given with chemo, so you can actually get a two for one, but that again that remains to bear out how the studies play out. What we’re really looking for is to find just what’s best for the patients and see. Chemo is still not going away anytime soon, especially for patients with what we call first-line therapy.

Carol Preston:   

So chemotherapy is not going to go away even though there are a lot of patients who are concerned about chemo with these new agents that are coming along. What do you say to them when they express that concern?

Dr. Spira:               

So you have to have a realistic talk. I mean chemotherapy is still the backbone of therapy for most of our patients with lung cancer. So that’s not going away anytime soon, and most patients in this day and age can probably do it. You can either modify the dose or come up with a regiment. I mean for those patients where it does—where they’re really not able, I’m not even sure that these drugs would be the right choice. But there [are] a lot of the new targeted therapies as well, and we’re hopefully moving towards that as well even instead of chemo, which is a completely different mechanism of action.

Carol Preston:   

You talked a little bit about the biomarkers of the subtext, which seems to me the next big frontier. So much has been poured into therapy. What’s going on in the research to really personalize this down to a person so that you can recognize these biomarkers and come up with that kind of targeted therapy?

Dr. Spira:               

So for PDL1 and PD1, it’s actually not as straightforward as a lot of the other treatments. It’s not like looking at an EGFR mutation, and the main reason it’s not a simple DNA test that’s yes or no. It’s a subjective test. It’s not a biopsy specimen, and it often requires interpretation that is not 100 percent clear, and it’s also not a completely linear relationship. So it’s not necessarily a yes or no answer, and there may be shades of gray. It’s also more complicated to do for labs.

The other interesting thing is all the companies that are making these different compounds using slightly different assays making it even more challenging to do, because what do you do, and how well does it work across? We are going to get there at some point. It’s just a matter of letting the dust settle, and these drugs have come along so fast and so exciting that the science hasn’t yet caught up to it, but we will.

Carol Preston:   

So if I’m a patient and I walk into your office, what questions should I be asking?

Dr. Spira:               

So you want to ask what’s right for me, what therapies should I get, is there a clinical trial for me, are there are any targeted therapies, will there be one in the future, and how do you maximize what treatments you have for me?

Carol Preston:   

And any final take-away message for patients? Lung cancer has been stubborn for those years, but obviously even with increasing diagnoses fatalities are coming down.

Dr. Spira:               

So when I started this 10 years ago, 13 years ago I guess, I’m getting old. The treatments hadn’t changed in forever, and the best we can do is compare four different chemotherapy regimens and throw our hands up. Now the treatments over the 10 years and really over the last five have changed dramatically. I mean we have targeted therapies. We have immunotherapies, and we have multiple new things coming down the pipe. So the prognosis has gotten much better. We’re still not going to for the foreseeable future take stage four patients and cure them and never come back, but we’re doing so much better that we only have the future to look forward to in all these new therapies.

Carol Preston:   

Dr. Alex Spira, that is very, very, encouraging news for patients, and obviously we all need to stay tuned. Perhaps you’ll come back next year and have even better news to report. I’m Carol Preston reporting from ASCO and remember that knowledge can be the best information of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on July 28, 2015