NSCLC: Immunoterapia e Terapia antiangiogenica

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NSCLC:

Immunoterapia e Terapia anti-

angiogenica

Alfredo Tartarone

Oncologia Medica

Centro di Riferimento Oncologico di Basilicata I.R.C.C.S.

Rionero in Vulture

21/09/2018

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2018

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●Durvalumab (Imfinzi): disponibile tramite programma di uso compassionevole: LA (stadio III) non operabile non in progressione dopo RT-CHT concomitante

●Pembrolizumab (Keytruda): in I linea in st IV PD-L1 TPS (Tumor Proportion Score) > 50%;

nel LA o st IV PD-L1 TPS > 1% dopo almeno un trattamento CHT

●Nivolumab (Opdivo): LA o st IV dopo un precedente trattamento CHT

●Atezolizumab (Tecentriq): LA o st IV precedentemente sottoposti a CHT

NSCLC: 2018 immunoterapici disponibili in Italia

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2017

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KEY Message:

Nel NSCLC LA non operabile lo Standard di cura è CT+RT

CONCOMITANTI seguiti da

Durvalumab

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I LINEA

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II LINEA

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Study Treatment OS

months

CheckMate 017 Nivo vs DCT Sq

9.2 vs 6.0 CheckMate 057 Nivo vs DCT

N-Sq

12.2 vs 9.4

OAK Atezo vs DCT 13.8 vs 9.6 Keynote 010 Pembro 2/10 vs

DCT

10.4/12.7 vs 8.5

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TMB: Tumor Mutational Burden

● Indicates the total number of mutations per coding area of a tumor genoma

● It’s an emerging biomarker of response to I-O therapies

● Currently, there is a lack of standardization

for TMB calculation and reporting

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Gandara et al Nat Med 2018 Aug 6

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KEYNOTE-189 nonSq-NSCLC

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Targeting angiogenesis in II line NSCLC

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Nindetanib (VARGATEF) is a new triple angiokinase inhibitor that potently blocks the proangiogenic

pathways mediated by vascular endothelial growth factor receptors, platelet-derived growth factor

receptors and fibroblast growth factor receptors

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On these bases, Nindetanib (VARGATEF) + DCT can

be considered a new option for the 2-line treatment

for pts with A-NSCLC with adenoca histology

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BEVERLY studio di fase III di confronto tra beva + erlotinib vs erlotinib in monoterapia come

trattamento di I linea di pz di pazienti con

Nsq-NSCLC e mutazione attivante dell’EGFR

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CONCLUSIONI

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●Antiangiogenesis (based on Beva+Platinum combo) continues being an effective treatment in nsq A-NSCLC

● Antiangiogenesis can be combined with I-O + chemotherapy increasing activity and without additional safety problems

● Nindetanib (VARGATEF) + DCT can be considered a new option for the 2-line treatment (adenoca histology)

● Crosstalk between EGFR and VEGF signalling pathways can be relevant in EGFR mutated pts; so, combination of antiangiogenic and anti-EGFR is an option and ongoing clinical trials are ongoing

Antiangiogenic Therapy: Key Messages

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