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Roundtable Discussion at ESMO on Immunology in Cancer

Part2: Immunotherapy ‘is coming to lung cancer!’

Experts Mary O’Brien (Royal Marsden Hospital, Sutton, Surrey, UK), Wilfried Eberhardt (University Hospital, Essen, Germany), Paul Baas (Netherlands Cancer Institute, Amsterdam) and Tony Mok (Chinese University of Hong Kong) discuss these and other questions in the emerging field of immunotherapy in lung cancer.

Immunotherapy is the new treatment paradigm in lung cancer, and data presented at ESMO 2014 demonstrated that a subset of patients derive remarkable long term benefits. But which patients?  No biomarker has been validated, and even when drugs are designed to target PD-1 or PD-L1 receptors, the picture is unclear. Patients may do well on these drugs, regardless of the PD-1/PD-L1 status of their tumour. Selecting patients for trials on the basis of PD-1/PD-L1 over-expression will deny many an effective treatment. But it may be the way to find start finding biomarkers. The KEYNOTE-042 study in Asia will test pembrolizumab against standard platinum-based chemotherapy as a first line treatment in patients with PD-L1 positive NSCLC.

Unusual toxicities are being seen. Oncologists and other clinicians will have to learn to recognise and deal with these toxicities, which will become increasingly common as patients survive longer on the new immunotherapies. And finally – how do researchers judge when a treatment is having the desired effect? Typical RECIST criteria may fail to distinguish between tumour progression and an immunological flare up which could be beneficial.

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