Questioning When to Start Immunotherapy for Patients With Oncogenic Drivers
May 21, 2020 01:00pm
By Karen Kelly, MD
Jamie E. Chaft, MD, discusses biomarkers used to identify patients with lung cancer who would benefit from immunotherapy and the possibility for future biomarkers in this setting.
Jamie E. Chaft, MD, a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center, discusses biomarkers used to identify patients with lung cancer who would benefit from immunotherapy and the possibility for future biomarkers in this setting.
Although there are rare mutations detected with next-generation sequencing which have shown correlation to response in patients with advanced disease, the leading biomarker besides PD-L1 status at the moment is tumor mutational burden (TMB). In oncology clinics, there are physicians that are either supporters or skeptics of this biomarker, but Craft believes TMB has a place in this setting once researchers can figure out how to test and define it. These findings will also need to be centrally validated.
Chaft thinks that for patients do not have tumors with high PD-L1 expression but do have high TMB, they are likely to respond to immunotherapy; there will need to be prospective studies in the high TMB population using monotherapy due to toxicity concerns with nivolumab (Opdivo) and ipilimumab (Yervoy). The National Comprehensive Cancer Network guidelines suggest when to use nivolumab and ipilimumab. There is a need for better biomarkers when it comes to immunotherapy because even though TMB is the next best biomarker after PD-L1 status, these biomarkers don’t compare to the oncogene predictive markers, according to Chaft.