NSCLC with Multiple Sites of Metastasis and No Driver Mutation - Episode 6
Mark A. Socinski, MD:As I previously mentioned, this patient represents treatable disease but not curable disease, and at some point, he is going to progress. Hopefully, when you’re followed closely, the disease progression is detected when the patient still has a good performance status. In the second-line settingand I clearly think there is value to second-line setting—the current standard of care is use of one of the immunotherapy drugs. We have data with nivolumab, pembrolizumab, and atezolizumab all compared to the old standard of docetaxel. And all 3 of those drugs easily beat the old standard docetaxel. So, over the past couple of years, the standard has changed from docetaxel to use of one of these immunotherapy agents in the second-line setting.
If the patient hadand this patient does not—a contraindication, some autoimmune disease that he couldn’t get immunotherapy from a safety point of view, then I typically, in that setting, use the combination of docetaxel plus ramucirumab. That’s a phase III tested regimen, docetaxel alone versus docetaxel plus ramucirumab. It had superior response, PFS, and overall survival rates. So, that’s my go-to regimen. And I would use that in the third-line setting following immunotherapy if the patient were eligible to get immunotherapy. I use it either second- or third-line. But I think right now, the best second-line option for these patients who have no contraindications to immunotherapy is use of either one of the PD-1 drugs, nivolumab or pembrolizumab, or the only PD-L1 agent, atezolizumab, in this particular setting.
You might get different opinions about which one is best in that setting, but the reality is that they all look very similar with regard to both efficacy and toxicity in this setting. So, I think that it’s nice to have choices, and we’re in the land of plenty in this area with regard to options for these patients. But that’s the standard in the second line.
Transcript edited for clarity.