Discussant of the IMpower010 abstract, Benjamin Besse, MD, PhD, Professor and Head of Clinical Research at Institute Gustave Roussy, Villejuif, France, said there is enough evidence to use adjuvant immunotherapy in stage II–IIIA resected non–small cell lung cancer (NSCLC), calling the increased separation of survival curves with an additional year of follow-up a “very good sign.”
Benjamin Besse, MD, PhD
According to Dr. Besse, however, previous studies have demonstrated initial improvements with adjuvant chemotherapy vs control only to have the arms cross many years later. For instance, a study of cisplatin-based adjuvant chemotherapy in patients with completely resected NSCLC ultimately crossed 7.5 years after initial randomization, he said, possibly due to the late effects of chemotherapy.1
“Ultimately, secondary endpoints, such as overall survival, should only be used to generate hypotheses,” said Dr. Besse. In addition, Dr. Besse noted that it will be important to follow the potential negative signal observed among patients with negative PD-L1 tumor expression. “When you look at overall survival in an adjuvant study, it’s important to see the crossover rate—how many patients in the control arm received atezolizumab or any immunotherapy—but this has not been reported,” he added.
Finally, Dr. Besse noted that liquid biopsies that measure circulating tumor DNA (ctDNA) will play an increasingly important role in the future to detect measurable residual disease (MRD). “Patients with detectable MRD after surgery have a very poor prognosis,” he explained. “Liquid biopsies with ctDNA will become a major tool to help build de-escalation trials and customize treatments for patients with positive MRD.”
DISCLOSURE: Dr. Besse disclosed financial relationships with 4D Pharma, AbbVie, Amgen, Aptitude Health, AstraZeneca, BeiGene, Blueprint Medicines, Boehringer Ingelheim, Celgene, Cergentis, Chugai Pharmaceutical, Cristal Therapeutics, Daiichi Sankyo, Eli Lilly, Eisai, Genzyme Corporation, GSK, Inivata, Ipsen, Janssen, Onxeo, OSE Immunotherapeutics, Pfizer, Roche-Genentech, Sanofi, Takeda, Tolero Pharmaceuticals, and Turning Point Therapeutics.
REFERENCE
1. Arriagada R, et al: Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350:351-360, 2004.
