touchRESPIRATORY touchRESPIRATORY
Start activity
 
Expert Interviews
Lung Cancer CE/CME accredited

touchEXPERT OPINIONS
Experts answer questions with in-depth advice on the current clinical landscape and how new therapies and guidance might impact regional clinical practice. Useful tips below will show how to navigate the activity. Close

Current and future considerations for the use of immune checkpoint inhibitors in non-small cell lung cancer

Take CE/CME Test

Dr Pilar Garrido is head of the Medical Oncology Department at the Ramón y Cajal University Hospital in Madrid, Spain, and associate professor of medicine at the University of Alcalá, Madrid. read more

Dr Garrido’s main areas of research are predictive biomarkers in lung cancer and gender perspective from different angles: The potential impact of gender in patients with lung cancer and the gender gap in oncology from a professional view. In addition, she collaborates very closely with national and international scientific societies and committees for the development of consensus documents and guidelines in the field of thoracic oncology. In 2020, she received the ASEICA  Woman Researcher Award for her contributions to the field.

Dr Garrido has long-standing experience in leading academic and pharma-sponsored clinical trials, being the national or international coordinator and local principal investigator (PI) of more than 150 studies, some of which have contributed to changing the standard of care and clinical practice in lung cancer.

She is co-director and PI of the Molecular Epidemiology and Predictive Cancer Biomarker Group at the Health Research Institute Ramón y Cajal.

Dr Pilar Garrido discloses: Advisory Board or panel fees from Abbvie, Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi and Takeda. Grants/research support from Amgen, AstraZeneca, Blueprint, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, IO Biotech, Lilly, MSD, Roche and Takeda.

Take CE/CME Test

Dr Pilar Garrido is head of the Medical Oncology Department at the Ramón y Cajal University Hospital in Madrid, Spain, and associate professor of medicine at the University of Alcalá, Madrid. read more

Dr Garrido’s main areas of research are predictive biomarkers in lung cancer and gender perspective from different angles: The potential impact of gender in patients with lung cancer and the gender gap in oncology from a professional view. In addition, she collaborates very closely with national and international scientific societies and committees for the development of consensus documents and guidelines in the field of thoracic oncology. In 2020, she received the ASEICA  Woman Researcher Award for her contributions to the field.

Dr Garrido has long-standing experience in leading academic and pharma-sponsored clinical trials, being the national or international coordinator and local principal investigator (PI) of more than 150 studies, some of which have contributed to changing the standard of care and clinical practice in lung cancer.

She is co-director and PI of the Molecular Epidemiology and Predictive Cancer Biomarker Group at the Health Research Institute Ramón y Cajal.

Dr Pilar Garrido discloses: Advisory Board or panel fees from Abbvie, Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi and Takeda. Grants/research support from Amgen, AstraZeneca, Blueprint, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, IO Biotech, Lilly, MSD, Roche and Takeda.

Take CE/CME Test

Dr Pilar Garrido is head of the Medical Oncology Department at the Ramón y Cajal University Hospital in Madrid, Spain, and associate professor of medicine at the University of Alcalá, Madrid. read more

Dr Garrido’s main areas of research are predictive biomarkers in lung cancer and gender perspective from different angles: The potential impact of gender in patients with lung cancer and the gender gap in oncology from a professional view. In addition, she collaborates very closely with national and international scientific societies and committees for the development of consensus documents and guidelines in the field of thoracic oncology. In 2020, she received the ASEICA  Woman Researcher Award for her contributions to the field.

Dr Garrido has long-standing experience in leading academic and pharma-sponsored clinical trials, being the national or international coordinator and local principal investigator (PI) of more than 150 studies, some of which have contributed to changing the standard of care and clinical practice in lung cancer.

She is co-director and PI of the Molecular Epidemiology and Predictive Cancer Biomarker Group at the Health Research Institute Ramón y Cajal.

Dr Pilar Garrido discloses: Advisory Board or panel fees from Abbvie, Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi and Takeda. Grants/research support from Amgen, AstraZeneca, Blueprint, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, IO Biotech, Lilly, MSD, Roche and Takeda.

Take CE/CME Test
  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Discuss the clinical implications for the latest data for immunotherapies in early-stage NSCLC
  • Evaluate the use of novel agents in combination with immunotherapy in NSCLC using the latest evidence
  • Describe how current and emerging biomarkers may guide immunotherapy treatment selection in NSCLC
Overview

In this activity, Dr Pilar Garrido, a leading expert in the management of non-small cell lung cancer (NSCLC), offers her insights on the role of immune checkpoint inhibitors in the treatment of patients with NSCLC, including the use of biomarkers to guide treatment decisions and the potential impact of recent clinical trial data on daily practice.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

Oncologists, including lung cancer specialists, and pulmonologists involved in the management of patients with NSCLC.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Pilar Garrido discloses: Advisory Board or panel fees from Abbvie, Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi and Takeda. Grants/research support from Amgen, AstraZeneca, Blueprint, BMS, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Janssen, IO Biotech, Lilly, MSD, Roche and Takeda.

Content reviewer

Alicia Canalejo, MSN, APRN-C has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Adriano Boasso has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 10 July 2023. Date credits expire: 10 July 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

Claim Credit

Topics covered in this activity

Lung Cancer
REGISTER NOW FOR FREE ACCESS TO
  • 1000+ topical and insightful peer-reviewed journal articles
  • 100+ hours of bite-sized congress highlights
  • 9 major therapy areas packed with the latest scientific advances
  • 150+ specialties offering learn-on-the-go medical education
  • + Concise email updates and newsletters so you never miss out
Register For Free Now
Claim Credit
touchEXPERT OPINIONS
Current and future considerations for the use of immune checkpoint inhibitors in non-small cell lung cancer
0.75 CE/CME credit

Question 1/5
You are considering neoadjuvant therapy for your patient with resectable NSCLC and a tumour diameter ≥4 cm. Assuming there are no contraindications for immunotherapy, which agent would you choose based on current FDA approval status?

FDA, US Food & Drug Administration; NSCLC, non-small cell lung cancer.

Nivolumab is FDA approved and recommended by the NCCN for the treatment of adults with resectable (tumours ≥4 cm or node positive) NSCLC in the neoadjuvant setting, in combination with platinum-doublet chemotherapy.1,2 In May 2023, the EMA CHMP adopted a positive opinion recommending a change in the marketing authorization for nivolumab,3 which has been subsequently approved by the EMA for the neoadjuvant treatment of adults with resectable NSCLC at high risk of recurrence and a PD-L1 expression of  ≥1%.4

Abbreviations

CHMP, Committee for Medicinal Products for Human Use; EMA, European Medicines Agency; FDA, US Food & Drug Administration; NCCN, National Comprehensive Cancer Network; NSCLC, non-small cell lung cancer, PD-L1, programmed death-ligand 1.

References

  1. FDA. Nivolumab Prescribing Information. 2023. Available at: https://bit.ly/3HAqZOb (accessed 25 April 2023).
  2. NCCN. Non-small cell lung cancer. V3.2023. Available at: https://bit.ly/3N8WDVc (accessed 7 June 2023).
  3. EMA. 2023. CHMP post-authorisation summary of positive opinion for nivolumab (II-117). Available at: https://bit.ly/3PP1aPp (accessed 7 July 2023).
  4. EMA. Nivolumab SmPC. Available at: https://bit.ly/437B9ht (accessed 30 June 2023).
Question 2/5
Your patient with stage III, locally advanced, unresectable NSCLC, and a PD-L1 expression of >1%, has received two cycles of platinum-based chemotherapy with concurrent radiotherapy without indication of disease progression. Her performance score is 0. What is your next step for this patient?

NSCLC, non-small cell lung cancer; PD-L1, programmed death-ligand 1.

The phase III PACIFIC trial compared durvalumab with placebo in patients with unresectable stage III NSCLC and no disease progression after concurrent chemoradiotherapy.1 At median follow-up of 61.6 months for censored patients (median follow-up for all patients was 34.2 months), median OS and PFS were greater with durvalumab than placebo (mOS: 47.5 vs 29.1 months; mPFS: 16.9 vs 5.6 months).1 OS and PFS benefit favoured durvalumab vs placebo across all PD-L1 subgroups, with the exception of OS in patients with a PD-L1 expression of <1%.1

Both the NCCN and ESMO guidelines recommend up to 12 months of consolidation immunotherapy with durvalumab for patients with unresectable stage II/III NSCLC, performance score 0–1, PD-L1 expression ≥1% (ESMO only2) and no disease progression after definitive concurrent chemoradiation.2,3

Abbreviations

ESMO, European Society for Medical Oncology; m, median; NCCN, National Comprehensive Cancer Network; NSCLC, non-small cell lung cancer; OS, overall survival; PD-L1, programmed death-ligand 1; PFS, progression-free survival.

References

  1. Spigel DR, et al. J Clin Oncol. 2022;40:1301–11.
  2. Remon J, et al. Ann Oncol. 2021;32:1637–42.
  3. NCCN. Non-small cell lung cancer. V3.2023. Available at: https://bit.ly/3N8WDVc (accessed 7 June 2023).
Question 3/5
Which of the following are key limitations of PD-L1 biomarker testing for treatment selection in patients with NSCLC?

NSCLC, non-small cell lung cancer; PD-L1, programmed death-ligand 1.

Although PD-L1 expression is currently used to guide treatment decisions and regulatory approval, several key limitations remain.1

  • PD-L1 expression shows both spatial (inter- and intra-tumour) and temporal heterogeneity, resulting in discordant PD-L1 status between samples and over the clinical course.1
  • Not all patients with high PD-L1 expression respond to anti-PD-1/PD-L1 therapy; responses have been seen in patients with low or negative PD-L1 scores.2–4
  • PD-L1 expression is a continuous rather than binary (positive vs negative) variable; arbitrary cut-offs are required to use PD-L1 as a biomarker, which may undermine its predictive power depending on the stringency of the cut-off.5

Abbreviations

NSCLC, non-small cell lung cancer; PD-1, programmed cell death protein 1; PD-L1, programmed death-ligand 1.

References

  1. Wang M, et al. J Thorac Dis. 2020;12:4541–8.
  2. Rittmeyer A, et al. Lancet. 2017;389:255–65.
  3. Antonia SJ, et al. N Engl J Med. 2017;377:1919–29.
  4. Carbone DP, et al. N Engl J Med. 2017;376:2415–26.
  5. Meyers DE, et al. Curr Oncol. 2018;25:e324–34.
Question 4/5
You have diagnosed your 60-year-old patient with unresectable, advanced, metastatic, non-squamous NSCLC. The tumour has a high PD-L1 expression of ≥50% and molecular testing indicates no EGFR- or ALK-positive tumour mutations. The patient has smoked for 40 years and their performance status is 1. Which of the following would you recommend as first-line treatment?

ALK, anaplastic lymphoma kinase; EGFR, epidermal growth factor receptor; NSCLC, non-small cell lung cancer; PD-L1, programmed death-ligand 1.

Pembrolizumab monotherapy is approved by both the FDA and EMA and recommended by the NCCN and ESMO for the first-line treatment of metastatic NSCLC in patients with a PD-L1 expression of ≥1%1 or ≥50%2–4 and no EGFR or ALK positive tumour mutations.1,2,4 Neither nivolumab monotherapy nor durvalumab monotherapy are FDA or EMA approved in this setting.1,2

Abbreviations

ALK, anaplastic lymphoma kinase; EGFR, epidermal growth factor receptor; EMA, European Medicines Agency; ESMO, European Society for Medical Oncology; FDA, US Food and Drug Administration; NCCN, National Comprehensive Cancer Network; NSCLC, non-small cell lung cancer; PD-L1, programmed death-ligand 1.

References

  1. FDA. PI for all agents available at: https://bit.ly/42WdeBv (all accessed 15 June 2023).
  2. EMA. SmPC for all agents listed available at: https://bit.ly/3CPrWPT (all accessed 15 June 2023).
  3. NCCN. Non-small cell lung cancer. V3.2023. Available at: https://bit.ly/3N8WDVc (accessed 7 June 2023).
  4. Hendriks LE, et al. Ann Oncol. 2023;34:358–76.
Question 5/5
What do the 4-year follow-up data from the CheckMate-9LA trial show about the OS benefit of first-line nivolumab plus ipilimumab combination therapy in addition to chemotherapy for patients with stage IV or recurrent NSCLC, compared with chemotherapy alone?

NSCLC, non-small cell lung cancer; OS, overall survival; PD-L1, programmed death-ligand 1.

A 4-year clinical update of the CheckMate-9LA trial, which tested first-line nivolumab plus ipilimumab with chemotherapy vs chemotherapy alone in patients with metastatic NSCLC were presented at the 2023 ASCO Annual Meeting. Data showed that nivolumab plus ipilimumab with chemotherapy continued to provide long-term, durable OS benefit compared with chemotherapy alone in all randomized patients. Durable efficacy benefit of combination immunotherapy was observed regardless of tumour PD-L1 expression or histology (squamous or non-squamous).

Abbreviations

ASCO, American Society of Clinical Oncology; NSCLC, non-small cell lung cancer; OS, overall survival; PD-L1, programmed death-ligand 1.

Reference

Carbone DP, et al. J Clin Oncol. 2023;41:LBA9023.

Back to Activity
Copied to clipboard!
accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72
Close Popup