ASCO 2016: Life-saving options for lung cancer patients

Welcome to ASCO – The American Society of Clinical Oncology, and it's annual conference.  I covered this onsite two years ago, learning some rookie lessons about comfortable footwear and conserving energy.  Here, at the world's biggest cancer conference, is often where major clinical trial findings are presented.

One significant study results presented on Saturday had the biggest breakthrough in oncology treatment taking on the biggest cancer head-on.  Lung cancer kills over 158,000 people a year – as much as the next five cancers combined.  That's someone every three and a half minutes.  That's a lot of lives.

Bristol-Myer Squibb's anti-PD-1 immunotherapy Opdivo (nivolumab) first made waves for melanoma, but it has been approved for other indications and now is showing significant promise for a specific set of lung cancer patients. Already approved for non-small cell lung cancer (NSCLC) in addition to melanoma and renal cell cancer, ongoing anti-PD-1 trials exist for nearly every type of cancer.

The CheckMate 012 study divided NSCLC patients into four groups, with differing rates of infusion and dosage (details here).  To summarize, there was between a 13 and 39% response rate across the groups; that in itself is a good result.  As an added bonus, the study looked at some specific biomarkers to see if there were segments of population that responded at a higher rate.  Guess what?  There was.

Of the patients who expressed PD-L1 on greater than 50%, 12 of 13 patients had a partial or complete response. That's remarkable.  Tumor cells have a ligand for PD-L1 – here's a picture that shows it much better than I can explain – and this ligand is one method cancer cells use to evade detection. Blocking this connection between the tumor cell's PD-L1 ligand and the T cell's PD-1 protein is how nivolumab (and Merck's pembrolizumab) allow the immune system to overcome the cancer cells.  Having a greater number of tumor cells expressing that ligand seem to be the first place to start, if possible, when making treatment decisions for NSCLC.

Granted, this is a relatively small trial and even smaller sample size – which is why studies are replicated in Phase 2 and 3 with larger populations – but if a bigger cohort gives even remotely the same results, Opdivo will have an extremely bright future as the right treatment for lung cancer patients.  It's one small but significant way researchers are continuing to identify what specific treatments will work for an individual, based on their unique cancer profile.  So for a specific subset of lung cancer patients, nivolumab is not only a good option – it's potentially a life-saver.

T.J. Sharpe shares his fight against Stage 4 Melanoma in the Patient #1 blog. Read more »