Dr Naiyer A. Rizvi on PD-1 Antibodies in Lung Cancer

Naiyer A. Rizvi, MD, director of thoracic oncology and immunotherapeutics at Columbia University Medical Center discusses the effectiveness of PD-1 antibodies in lung cancer.

Transcript

We know that the PD-1 antibodies are active in lung cancer. Historically, there’s really been no immunotherapy that has worked at all, that we know of, in lung cancer. It’s really been in melanoma or kidney cancer where we’ve seen benefits, so we’re all surprised when we had lung cancer patients responding to PD-1 therapy—this was back in 2008/2009.

Since then, we see about 15% to 20% of patients that clearly benefit from these therapies. The longest-term survival is at about 5 years, where we have about 18% of patients that are still doing well after PD-1 therapy. So, the flip way of looking at it is that we have 18% who are alive at 5 years, which would have been zero 10 years ago. I think the reasons why only a subset actually benefit is that lung cancer is a very heterogeneous disease—there’s patients who have EGFR mutations, ALK rearrangements, some are smoking-related. So, it’s really the subset which tends to be the most genetically damaged—the most similar, if you will, to melanoma—where the chronic UV light exposure induces damage to cells. So, melanoma may have hundreds to thousands of mutations within the tumor, which in turn, makes it a more immunogenic tumor. Within the whole spectrum of lung cancer, there’s probably only 20% or 30% which would be comparably, highly mutated, immunogenic in nature.