An immunotherapy now approved for first-line treatment

[MFH_Advocate]

Late yesterday, the FDA approved Keytruda (an immunotherapy) as a first-line treatment for patients with lung cancer whose tumors express high levels of PD-L1. This means that Keytruda could be used as the first treatment after diagnosis (instead of chemotherapy) in some patients.

[Jessi08 Volunteer]

Great news Mary!!! What is PD-L1? Does it have to do with a genetic marker? Thanks

[FtB_Travis in reply to Jessi08]

MFH_Advocate ? (I tagged her for you Jessi08 ; that way she will get a notification)

[MFH_Advocate in reply to Jessi08]

Hi Jessi08

PD-L1 is a protein that can be "overexpressed" by tumor cells (ie, the tumor makes more PD-L1 than normal). PD-L1 is being used as a biomarker because patients who have high levels of PD-L1 seem to have a better response to immunotherapies.

The PD-L1 on tumor cells is one way that the tumor "tricks" the immune system into not attacking the tumor. Some immunotherapies work by blocking PD-L1. The end result is that the immune system can start to recognize and attack the tumor.

Free to Breathe has a brochure and information on our webpage as well:

freetobreathe.org/lung-canc...

I hope this helps!

[Jessi08 Volunteer in reply to MFH_Advocate]

Always helpful!!! Thank you!!!

[by020139]

Wonderful news! I was on the Keytruda trial for two years, after chemo/radiation for the previous year and a half, didn't work. So glad it's first line treatment for everyone!

[GailO]

I was told at Mayo that it doesn't work as well for never smokers.

[MFH_Advocate in reply to GailO]

Hi GailO Thank you for your comment! Research on differences between smokers and nonsmokers diagnosed with lung cancer is ongoing and we hope to learn more about which patients are most likely to respond to immunotherapies. Keep in mind that immunotherapy is relatively new and understanding why some individual patients respond and some don't is still an active area of research.

[MFH_Advocate in reply to MFH_Advocate]

Hi again GailO

Late last week, I heard some researchers discussing this very topic! The OAK study of atezolizumab showed that it seemed to work regardless of smoking status. Here is a quote from an online article: "Naiyer Rivzi, MD, from Columbia University Medical Center, New York City, said atezoluzimab showed a slightly different safety profile from the profiles previously seen with PD inhibitors nivolumab and pembrolizumab, and the efficacy was slightly different; he particularly noted, "Its efficacy in never-smokers was compelling." I still think we need to know more, but so far, the news is hopeful!

[GailO in reply to MFH_Advocate]

If you could send a link to that info, I'd appreciate it.

[MFH_Advocate in reply to GailO]

I used the quotes from a medscape article, but you may need to log in to see it: medscape.com/viewarticle/87...

ASCO also has a video about the OAK trial and mentions that atezolizumab worked regardless of "never smoking" at the very end (about 3:30 on the video): ascopost.com/videos/2016-es...

Another summary can be found here: mdedge.com/chestphysician/a...

I would expect a full article about the study to be published soon. Thanks!

[GailO in reply to MFH_Advocate]

Thanks much.

[scifiknitter Blogger]

I think this has the potential to greatly change the standard of care for lung cancer patients. PD-L1 testing will be added to testing for the common driver mutations for newly diagnosed patients, and Keytruda will become the preferred first line of treatment. This is genuinely exciting!

[Dragracer]

I will be starting Keytruda on Monday the 14 of Nov. Went through chemo and radiation starting in February. In June was told cancer was in remission. Then in August it reared its ugly head. Tried opdivo for 3 treatments and cancer grew. Dr wants to try Keytruda for 12 weeks and then do a new scan. I know we have to wait to see if it is working but I think that is to long to wait

[MFH_Advocate in reply to Dragracer]

Dragracer I know you must be having so many different feelings about trying a new therapy. I hope you are able to talk to your doctor about any questions or concerns. Sometimes scans seem to show that the cancer is getting worse after starting an immunotherapy, but it is actually something called "pseudoprogression." With immunotherapy, the body's immune cells start attacking the tumor. As more and more immune cells attack the tumor, the tumor might look like it is getting bigger on scans (pseudoprogression). But, if immunotherapy is working, the tumor eventually starts to "shrink." That's why some doctors wait to do a scan. I can only imagine that waiting 12 weeks seems like an eternity, but please know that many doctors use this approach. If scans are done too early, doctors might not be able to tell if the cancer is getting worse or if they are seeing pseudoprogression. Please keep us posted as to how you are doing.

[Dragracer in reply to MFH_Advocate]

Thank you so much. I sure hate all of the ups and downs. I just want to know what to do next

[Arkoia]

I thought I saw recently ketrudia is not for the efrg and AlK mutations. Is this correct?

[MFH_Advocate]

Hi Arkoia That is another great question! And, yes, pembrolizumab (Keytruda) is approved for use as a first-line (initial) treatment for patients whose tumor has high levels of PD-L1, but does not have EGFR or ALK mutations. And patients whose tumors are EGFR or ALK positive should have had disease progression on a targeted therapy before being treated with Keytruda.

So, what does this mean? Well, if someone has EGFR- or ALK-mutated lung cancer, starting treatment with a targeted therapy is a very important treatment option and definitely one to be discussed with your doctor. Researchers continue to look at which patients will benefit the most from immunotherapy and, hopefully, we will have even more information to help choose the best treatments for an individual patient.