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WS03 - ITONF Workshop: Bridging the Gaps in Thoracic Oncology Nursing - A Global Perspective (Sign Up Required) (ID 104)
- Event: WCLC 2019
- Type: Workshop
- Track: Nursing and Allied Professionals
- Presentations: 1
- Now Available
- Coordinates: 9/07/2019, 11:00 - 18:00, San Francisco (2009)
WS03.08 - Panel - Emerging Therapies - Immunotherapy (Now Available) (ID 3673)
11:00 - 18:00 | Presenting Author(s): Marianne Davies
IASLC Abstract for Presentation.
By Rachel Thomas
This panel session will focus on emerging immunotherapies, the aim is to bring the UK perspective to the panel particularly focusing on the role of the Lung Cancer Clinical Nurse Specialist (CNS) and how to support and counsel patients who are about to commence one of the new therapy combinations. The presentation from the UK will look at the current therapies in immunotherapy and then also look at two case studies which will bring the clinical trial data into real time perspective.
In the UK there have been no new immunotherapies launched, however, what the landscape of immunotherapies is changing in the UK for non-small cell lung cancer patients in the form of multi-drug combinations. Most recently we have seen the introduction of Durvalumab as a treatment for locally advanced unresectable non-small cell lung cancer post platinum based chemoradiation (1). This combination is still awaiting formal NICE approval but NHS patients can access this via a Cancer Drugs Fund. The PACIFIC Trial demonstrated that patients who received Durvalumab after platinum based chemoradiation had a significant improvement in their progression free survival when compared to chemoradiation plus a placebo. The median duration of progression free survival was 17.2 months in the Durvalumab arm compared to 5.6 months in the placebo arm. The median time to death or distant metastases was 28.3 months in the Durvalumab arm compared to 16.2 months in the placebo arm (2).
In the advanced metastatic setting there has recently been the introduction of the KEYNOTE-189 data which is looking at pembrolizamab + platinum/pemetrexed in patients who did not have any molecular mutations. This trial demonstrated an overall survival with a 51% reduction in the risk of death and superior progression free with a 48% reduction in the risk of progression or death.
In March 2019 The IMpower150 trial showed significant improvements in progression-free and overall survival with atezolizumab plus bevacizumab plus carboplatin plus paclitaxel (ABCP) versus the standard-of-care bevacizumab plus carboplatin plus paclitaxel (BCP) in chemotherapy-naive patients with non-squamous metastatic non-small-cell lung cancer who have an ALK rearrangement or who have an EGFR mutation. This combination has now been approved by NICE and will provide patients who progress on a tyrosine kinase inhibitor a multi-drug treatment combination which has been demonstrated in the Impower 150 trial to deliver overall survival of around 19.2 months when compared to bevacizumab/carboplatin and paclitaxel.
The UK has demonstrated the importance of the input of the Lung Cancer CNS in supporting patients who are about to commence treatment and also in proactively monitoring patients for potential adverse events (3). However, with the emergence of multidrug treatments how do we as Lung Cancer CNS’s assess which adverse events are related to the immunotherapy and which are related to the chemotherapy. Looking at the current clinical trial data from the studies above and then focusing on two real life patient case studies will provide some clear guidance on how to support patients whilst monitoring for any potential adverse events and dealing with these in a timely and accurate manner. The table below sets out just some of the main challenges faced in identifying immunotherapy related adverse events.
We as nurse specialists are now experienced at caring for patients on single agent immunotherapy treatments but one of the many challenges is that many lung cancer patients will have co-morbidities which can cloud the identification of immunotherapy adverse events. For example 40-70% of lung cancer patients will also have a diagnosis of COPD. Pneumonitis can present in a very similar pattern to organising pneumonia and chest infections meaning that accurate and detailed assessments are needed to ensure adverse events are identified and treated accordingly. However, when you also add into the treatment plan platinum doublet chemotherapy with or without radiotherapy the potential for adverse events increases, the panel will look at the PACIFIC data to assess the reporting of adverse events in this patient group. The panel will also then assess the trial data for platimum doublet chemotherapy and immunotherapy in the treatment of metastatic non-small cell lung cancer and whether this patient group with a potentially higher symptom burden reported an increase in the number of adverse events when compared to either single agent immunotherapy or platinum doublet chemotherapy alone.
One other important focus of the panel discussion will be to look at what the future treatment landscape for patients may be and how this will impact on progression free survival and living with lung cancer. This will mainly cover recent updates from ASCO and will aim to provide a flavour of what we may see coming into clinical practice in the coming months.
Durvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation. Technology appraisal guidance [TA578] Published date: 01 May 2019. https://www.nice.org.uk/guidance/TA578
Overall survival with Durvalumab after chemoradiotherapy in Stage III NSCLC. Scott. A; Augusto, V; Davey, D et al. www.nejm.org/doi/full/10.1056/NEJMoa1809697.
The National Lung Cancer Audit (2018) www.rcplondon.ac.uk/projects/national-lung-cancer-audit
Yoest JM (2017) Clinical features, predictive correlates and pathophysiology of immune related adverse events in immune checkpoint inhibitor treatments in cancer: a short review. Immunotargets Therapeutics. 6. P 73-82.
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