TOP - August 2018, Vol 11, No 2

In the August issue of The Oncology Pharmacist (TOP), we feature results of a clinical trial presented at the 2018 American Association for Cancer Research meeting, which showed that the addition of the immune checkpoint inhibitor pembrolizumab to chemotherapy yielded significantly longer overall survival and progression-free survival compared with chemotherapy alone in patients with newly diagnosed metastatic nonsquamous non–small-cell lung cancer.

Although the FDA approval of the 2 kinase inhibitors, lenvatinib (Lenvima) and sorafenib (Nexavar), has improved progression-free survival (PFS) rates, the responses to treatment with these agents are not durable and more treatments are needed.

A burning question is whether immunotherapy combinations will further improve outcomes compared with checkpoint inhibitor therapy alone—and if so, which combinations will rise to the top.

Based on research presented at the 2018 National Comprehensive Cancer Network Annual Conference, patients weighing 60 kg to 85 kg who often receive lower-than-recommended doses of filgrastim, without evidence of its noninferiority to recommended doses, is found to be not only acceptable, but also cost-saving.

The FDA granted accelerated approval to nivolumab based on a notable clinical benefit in a subset of patients who progressed after receiving the standard first-line chemotherapy with fluoropyrimidine, oxaliplatin, and irinote­can.

A starting dose of regorafenib (Stivarga) 80 mg daily with dose escalation to 160 mg daily was better tolerated than starting at 160 mg daily, with a trend toward improved survival in the management of patients with metastatic colorectal cancer.

Among the 84 patients, 7 had partial responses with the combination of atezolizumab (Tecentriq) and cobimetinib (Cotellic). The median duration of response was 14.3 months.

The combination cohort consisted of 119 patients who received nivolumab 3 mg/kg plus ipilimumab 1 mg/kg every 3 weeks for 4 doses followed by nivolu­mab 3 mg/kg every 2 weeks. The median follow-up was 13.4 months.

“We find that T-cells with highly activated glycolysis pathways ended up performing worse when we tried to make them into CAR T-Cells. Substituting and supplementing heavily with fatty acids did seem to improve this a little,” said David M. Barrett, MD, PhD, at the 2018 American Association for Cancer Research annual meeting.

Current National Comprehensive Cancer Network guidelines recommend initiating radiation therapy within 6 weeks of tumor resection, but the benefits of shorter time to radiation therapy, including locoregional control and survival, remain inconclusive.