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Enrolling Patients With Lung Cancer into Clinical Trials for Immunotherapy

Paul A. Bunn, Jr., MD
Published Online:2:53 PM, Wed October 2, 2019

Paul A. Bunn, Jr., MD, Distinguished Professor, James Dudley Chair in Lung Cancer Research, Division of Medical Oncology, University of Colorado Denver, discusses subsets of patients with lung cancer that can benefit more from enrolling on clinical trials with immunotherapy compared with patients who do not benefit as much from immunotherapeutic approaches. Immunotherapy does not work in every patient, Bunn notes.

Patients who are never-smokers or who harbor a molecular driver, such as EGFR, ALK, ROS1, or TRK, will have a higher response rate with oral agents, such as tyrosine kinase inhibitors (TKIs). The best approach to enrolling patients on clinical trials is to determine which patients have molecular drivers and exclude those patients from neoadjuvant immunotherapy trials since they are less likely to benefit from treatment. For these patients, there will be another treatment that could be more beneficial to them.

Bunn says we can learn why some of the cells persist after surgery when we give patients with molecular drivers TKIs prior to surgery. In stage IV disease, TKIs do not cure disease; they will kill some cancer cells, but the rest remain despite having the same molecular abnormality. Researchers do not know why this occurs, so rational combinations cannot be developed. However, Bunn says looking at persisting cells at the time of surgery in neoadjuvant trials with TKIs for specific drivers will hopefully help in the development of new novel therapies that can improve the cure rate in lung cancer.
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