ECC 2015

Latest in lung cancer from ECC 2015

Prof Martin Reck - Lung Clinic Grosshansdorf, Grosshansdorf, Germany

Martin, you’re involved in a lot of things here but let me ask you, we’ve been hearing an awful lot about non-small cell lung cancer. The exciting thing, although quite a costly thing, is moving into immunotherapy, the latest type of immunotherapy. Could you survey the landscape of this whole scene for me please?

Yes, with great pleasure because we are really passing a very exciting new area in treatment, in systemic treatment, of lung cancer. So checkpoint inhibition is a completely new concept besides chemotherapy and targeted therapy and what we have seen now in two large randomised trials that checkpoint inhibition by a PD1 antibody, nivolumab, is superior to conventional chemotherapy, docetaxel. We have seen this in two large trials in pre-treated patients and now we also have a label for nivolumab in pre-treated patients with squamous cell histology. If we look on the Kaplan-Meier curves we haven’t seen such curves before in the scenario of pre-treated patients with advanced lung cancer.

Where do you see these therapies fitting in to the present scheme of things for ordinary cancer doctors working to do their best for their patients?

Currently we have the confirmation of proof in pre-treated patients in second line, third line. But we have a huge variety of trials going on in other settings so we have a number of trials going on in first line patients, we will see the data next year. We have a large number of trials going on in locally advanced stage of disease and we also are now going to investigate these really exciting compounds in other tumour types like small cell lung cancer.

And the take-home for doctors at this point in this immunotherapy is what?

Immunotherapy will really refine systemic treatment in non-small cell lung cancer. We will start with second line treatment but it will have a major impact on our huge schedule of systemic treatment in lung cancer.

Now, I know you’re going to be presenting on some of the best abstracts here and you have another one on lung cancer. Could you tell me about this ETOP study?

This is quite an interesting project, it’s a co-operation of the European Thoracic Oncology Platform and the Spanish Lung Cancer Society. They are investigating a new combination of erlotinib, an EGF receptor TKI, and bevacizumab, a VEGF antibody, in patients with an EGF receptor mutation.

One of the problems might be toxicity with such a combination though?

This is something which has to be considered. We are seeing some side effects, however if you look on the details the majority of side effects have been associated with, let’s say, manageable side effects like hypertension or myeloid toxicity or something like this.

So what do you think is the potential of this combination of those two drugs?

We have seen from a randomised trial in Japanese patients that we may improve the efficacy of erlotinib by the addition of bevacizumab. So progression free survival significantly has been improved in this trial and we are really seeing the same signal here in the ETOP trial again. So it seems that indeed the efficacy of the combination erlotinib-bevacizumab is superior to erlotinib alone. This also might be related to the fact that in case of the T-cell 90M mutation that VEGF inhibition may delay the clinical progression of the disease. So this is very interesting. We have to confirm these results in randomised trials, there are trials going on, randomised phase III trials, investigating this concept but this is very exciting.

There has been quite a bit of news and all of this, of course, is very encouraging for non-small cell lung cancer but what about small cell? One of the abstracts you’re looking at is bringing some good news into small cell cancer as well, isn’t it?

This is also very exciting and we haven’t seen so much good news in small cell in the recent years. Now, this is a new compound, it’s an antibody conjugate, rovalpituzumab. It’s interacting with one of the NOTCH receptors and the interesting thing is we have seen tremendous responses in patients with pre-treated small cell lung cancer and the other very interesting thing is that efficacy seems to be linked to the over-expression of this receptor D3. So perhaps for the first time we do have a targeted treatment for small cell lung cancer. I think this is really great news, in particular in pre-treated patients with metastatic small cell lung cancer.

Now, in many people’s eyes lung cancer therapy didn’t really move on in leaps and bounds but it seems as if that’s changing now. What’s your assessment for doctors?

I think lung cancer has become extremely exciting. We do see tremendous results for new therapeutic options. We will need some years to confirm this data in really validated randomised trials. It will take a couple of years to see these improved survival rates also in our statistics but overall I really see that there is a growing dynamic development in systemic therapies in patients with lung cancer.