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Expert Point of View: Heather A. Wakelee, MD, FASCO, and Erika Hlavacek


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Heather A. Wakelee, MD, FASCO

Heather A. Wakelee, MD, FASCO

Heather A. Wakelee, MD, FASCO, President of the International Association for the Study of Lung Cancer (IASLC), who moderated a press briefing where the results of the Atezo-Brain trial were presented, called the study “beautiful work designed specifically” for patients with non–small cell lung cancer (NSCLC) and brain metastases. “It’s a great study that adds to emerging information; when patients are otherwise eligible for checkpoint inhibitors and chemotherapy, we should not exclude them because of brain metastases.”

“In the past, there was much concern that immune checkpoint inhibitors could perhaps lead to poor outcomes in the brain because of the potential for swelling, so early clinical trials excluded these patients,” said Dr. Wakelee, who is also Professor of Medicine, Chief of the Division of Oncology at Stanford University, and Deputy Director of the Stanford Cancer Institute. “This got me quite irate, because I believe that excluding the patients most in need of good therapies does not make sense.”

Dr. Wakelee added that she also hopes an effective regimen such as this one can help patients avoid whole-brain radiotherapy. “For too long, our reflex was to give radiotherapy if the patient is diagnosed with brain metastases, sometimes even before waiting for the molecular testing results, which might identify a driver mutation we can now treat. Whole-brain radiotherapy can take its toll, and you can’t take that back, even if we develop the best new cure for cancer…. The current study shows that atezolizumab and pemetrexed/cisplatin is a very good regimen.”

Patient Advocate Weighs in on Clinical Trials

At a press briefing, patient advocate Erika Hlavacek, who was diagnosed with ALK-positive stage IV NSCLC in 2017 at the age of 42, agreed with Dr. Wakelee. “As someone who has had brain metastases, I was pleased to see a clinical trial highlighting this population. Brain metastasis is frequently an exclusion criterion in clinical trials, and thus it remains an unmet need,” she said.

Erika Hlavacek

Erika Hlavacek

Ms. Hlavacek continued: “Many patients with lung cancer participate in trials at a time when they are out of other options and crucially need a treatment plan. Being excluded from a trial because of brain metastasis is difficult for patients to hear. Trials are mutually beneficial entities: patients need treatment, and researchers need data.”

Ms. Hlavacek is the founder of a nonprofit organization that raises money for lung cancer research (yEAHbestlife.org). 

DISCLOSURE: Dr. Wakelee has served as a consultant or advisor to AstraZeneca, Blueprint Medicines, Daiichi Sankyo, Helsinn Therapeutics, Janssen Oncology, Mirati Therapeutics, and Xcovery; has received institutional research funding from ACEA Biosciences, Arrys Therapeutics, AstraZeneca/MedImmune, Bristol Myers Squibb, Celgene, Clovis Oncology, Exelixis, Genentech/Roche, Gilead Sciences, Merck, Novartis, Pharmacyclics, Seattle Genetics, and Xcovery; and has held uncompensated relationships with Genentech/Roche, Merck, and Takeda. Ms. Hlavacek reported no conflicts of interest.


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