Christine Dierks, MD

Christine Dierks, MD, senior physician at the University Hospital Freilburg in Germany, discusses how PD-L1 expression is used to determine treatment for patients with thyroid cancer.

Dierks says that regarding the PD-L1 levels used for the tumor proportion score (TPS) and combined positive score (CPS), physicians look at the PD-L1 expression on the membrane of the tumor cells. They also look at the frequency of the infiltrating immune cells and infiltrating lymphocytes to see if they express PD-L1 or PD-1 on the cell’s surface. To histologically characterize the immune phenotype of a tumor, they need to see the level of expression on these different parts of the tumor.

With differentiated thyroid carcinoma, physicians usually see TPS that is either negative or very low, below 10%. In over 70% of patients with anaplastic thyroid carcinoma, the TPS is often above 50% and the CPS above 75%, according to Dierks. She says these scores are some of the prognostic markers for response to immune checkpoint inhibitors in patients with non–small cell lung cancer.

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Christine Dierks, MD, discusses how PD-L1 expression is used to determine treatment for patients with thyroid cancer.

PD-L1 Expression in Relation to Patients With Thyroid Cancer

Christine Dierks, MD, senior physician at the University Hospital Freilburg in Germany, discusses the early data from a study looking at the combination of lenvatinib (Lenvima) and pembrolizumab (Keytruda) in patients with metastatic anaplastic or poorly differentiated thyroid carcinoma.

This trial was the same drug combination and patient population as the phase 2 ATLEP study that Dierks was a part of. Similarly, patients had previously treated disease with multiple therapies, such as chemotherapy, except for lenvatinib and pembrolizumab.

At the European Society of Medical Oncology (ESMO) Virtual Congress 2020, the data for the first 20 patients after 3 months was presented and the rest will not come out for a long period of time, according to Dierks. The response rate after 3 months was 30% and the best overall for patients was 50%, including some patients who are 9 months into the regimen. She says the overall response is slowly improving over time as patients go further on therapy.

The time to response with the combination is slow and complete remission rates were seen in 8 patients and the first complete remission was seen after 11 months of treatment. Dierks believes that patients have to stay on therapy for a long period of time to achieve complete response.

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Christine Dierks, MD, discusses the early data from a study looking at the combination of lenvatinib and pembrolizumab in patients with metastatic anaplastic or poorly differentiated thyroid carcinoma.

Early Data Presented for Lenvatinib and Pembrolizumab in Thyroid Cancer

Christine Dierks, MD, senior physician, University Hospital Freilburg, Germany, discusses the results from the prospective phase 2 ATLEP study of lenvatinib (Lenvima) in combination with pembrolizumab (Keytruda) as treatment of patients with metastatic anaplastic or poorly differentiated thyroid carcinoma.

In this study, 4 out of 8 patients achieved a complete response (CR) with the combination, and of the 4 patients, 3 are still alive, says Dierks. All patients who achieved a CR had anaplastic thyroid carcinoma.

Biomarkers observed in this small cohort of good responses included high PD-L1 status and increased tumor mutational burden. The median progression-free survival was 17.75 months, and the median overall survival is 19 months. The longest duration of treatment was 40 months in 1 patient, and 3 patients remained alive, receiving pembrolizumab monotherapy as the lenvatinib is stopped on the study when responses are achieved.

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Christine Dierks, MD, discusses the results from the prospective phase 2 ATLEP study of lenvatinib in combination with pembrolizumab as treatment of patients with metastatic anaplastic or poorly differentiated thyroid carcinoma.

Christine Dierks, MD | Authors

Articles

PD-L1 Expression in Relation to Patients With Thyroid Cancer

Early Data Presented for Lenvatinib and Pembrolizumab in Thyroid Cancer

Pembrolizumab/Lenvatinib Combo Achieves Promising Responses in Anaplastic Thyroid Cancer