At a reception well attended by many prominent thoracic oncologists this week, after the last lung cancer sessions of this year’s ASCO Annual Meeting had ended, the atmosphere was jubilant. Some were relieved that their presentations had gone well and that they could finally relax. Most were glad it was almost time to go home and see their loved ones again after four, five, or more days away. But my sense from the group was that there was more to it than that, that 2015 had finally been a year where potential gave way to real change for lung cancer patients, and that we were all a part of it.
On Saturday morning, I attended the Special Session on Immunotherapy, where the CheckMate 057 trial of nivolumab versus docetaxel for previously treated non-squamous non-small cell lung cancer (NSCLC) was being presented. Despite showing up 10 minutes early, the enormous room D1 was not just packed but standing room only.
When Dr. Paz Ares presented the survival curves showing a three-month median improvement in Overall Survival (OS) for the PD-1 drug over the previous standard of care—with PDL-1 expressers having an OS improvement ranging from eight to 11 months—there was a hush broken only by the sound of thousands of smartphone cameras clicking to record the slide on the giant screen.
When the discussant explained the significance and concurred with my feelings that this represented a new standard of care for our patients, I couldn’t wait to tweet his words out to the world. This wasn’t just another positive phase III trial; this was something I could use now for my patients (and I had a list already in my head) that would help them, just maybe, live substantially longer than they would have before. And for the first time in the nine ASCO Annual Meetings I had attended, I was there to see real practice-changing data presented for the very first time. It was magical.
And things were only getting started. In the small cell lung cancer (SCLC) oral session, usually a place one only attends to bring you back to earth if you’re feeling a little too upbeat that day, the combination of 2 checkpoint inhibitors in relapsed/refractory SCLC had a response rate of 32% and the responses appeared durable, even in chemo refractory patients. In another phase III trial, the addition of an antiangiogenic (bevacizumab) to chemotherapy improved survival in patients with pleural mesothelioma. In the NSCLC Oral Session, we saw biomarker-driven subgroup of patients, those with V600E BRAF mutations, have a 68% response rate to combined BRAF and MEK inhibition, while in another presentation patients with RET fusion-driven lung cancer benefited from RET inhibitors. Something was definitely different this year and people could feel it.
Finally, on Sunday night, I was fortunate enough to be allowed to chair the Clinical Science Symposium in which the second phase III trial comparing nivolumab to chemotherapy was presented, this time in patients with squamous cell lung cancer (CheckMate 017). The data and OS benefit were already known, and the drug was already approved earlier this year for this group. Nonetheless, the room remained packed, and it was truly a humbling experience to sit up there and stare at several thousand people while they waited to hear what the speaker had to say.
It was the culmination of an amazing experience, starting and finishing with practice-changing trials bookending the Meeting. I felt incredibly fortunate to have been a participant in the process, even just as an observer. And when the curves flashed up on the one-story-tall screen, there was the same hush, the same clicks. It was still magical, but now it was time to reflect on these findings and take them back to our patients. And, of course, it was time to party.
Jeffrey J. Kirshner, MD
Jun, 08 2015 2:05 AM
Amazing indeed. It is going to get very interesting as we try to get these drugs for our patients. Working on getting Nivo for a young woman with met adeno NSCLC already a 3 yr survivor on TKI'sand taxotere. The battles begin on two fronts
Mark Allen O'Rourke, MD
Jun, 08 2015 11:06 PM
Well said. I too have a list of lung cancer patients to consider for immunotherapy.