Results from the Sexual Health Assessment in Women with Lung Cancer (SHAWL) study highlight the need for health interventions in thoracic oncology care, according to Narjust Florez, MD.

Among 127 participants who had attempted sexual activity within 30 days of completing a survey, 77% reported moderate to severe sexual dysfunction. Of these, 59% (n = 75) had experienced significant issues with vaginal dryness and 26% (n = 63) had experienced vaginal discomfort during sexual activity.

In a direct comparison before and after a diagnosis of lung cancer, there were stark changes in sexual desire and interest (15% vs 31%; 

 < .001) and vaginal pain and discomfort (13% vs 43%; 

“The results were sobering,” Florez said in a presentation during the IASLC 2022 World Conference on Lung Cancer. Florez is associate director of the Cancer Care Equity Program and a thoracic medical oncologist at the Lowe Center for Thoracic-Oncology and the Dana-Farber Institute. “This means [that] this is affecting the patient’s quality of life. This is a daily matter for many of these patients.”

Florez said that the study did not limit sexual health to penetrative/vaginal sex, but encompassed all forms of intimacy, such as cuddling, kissing, oral sex, and masturbation. The study results showed that female patients with lung cancer were experiencing moderate to severe changes in various intimate settings.

According to Florez, most patients with lung cancer (up to 95%) receive a sexual dysfunction score below the 50th percentile and, unfortunately, most sexual dysfunction–related issues do not improve over time. Sexual dysfunction has been linked to higher symptom distress and worse functional status.

Despite previous efforts have been undertaken to catalogue the experiences of this patient population, few data exist regarding how patients receiving checkpoint inhibitors and targeted therapies have been affected by changes in sexual health. The effect of newer treatment strategies on patients’ sexual health is largely under-reported, and consequently understudied, Florez said.

The SHAWL study was an observational, cross-sectional, international effort to query patients about their experiences. The study used PROMIS questions in a self-reported online questionnaire and was administered to patients with lung cancer in collaboration with the GO2 Foundation for Lung Cancer and the lung cancer registry.

The survey queried 249 participants. The age range was 29 to 84 years, and the average age of respondents was 59.9 years. Most patients were non-Hispanic Whites (88%) and 81% had a diagnosis of non–small cell lung cancer. Nearly half (45%) were receiving a targeted therapy treatment.

The findings showed that the factors most likely to affect sex life satisfaction included fatigue (40%), feelings of unhappiness (28%), issues with partners (22%), and shortness of breath (15%). Florez noted that shortness of breath is a factor unique to this patient population.

Study authors acknowledged that this study was limited to the US and primarily consisted of non-Hispanic White participants, and that, because sexual health is influenced by cultural beliefs, this represents a limitation. Moving forward, the Florez and other coinvestigators plan to launch the intervention phase of research and seek ways to improve the quality of life for patients who are facing sexual health changes.

Florez N, Acharya R, Wei1 Z, et al.Sexual health assessment in women with lung cancer (SHAWL) study. Presented at: IASLC 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria. Abstract MA14.04

Sarna L. Correlates of symptom distress in women with lung cancer. Cancer Pract. 1993;1(1):21-28.

Bober SL, Sanchez Varela V. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol. 2012;30(30):3712-3719. doi:10.1200/JCO.2012.41.7915

Articles

Findings from the SHAWL study found that sexual dysfunction rates are high among women with lung cancer. 

Integration of Sexual Health Considerations Into Thoracic Oncology Care Is Critical 

Providers concerned about improving tolerability with sotorasib (Lumakras) plus pembrolizumab (Keytruda) or atezolizumab (Tecentriq) may consider a lead-in dosing strategy, according to data presented at the 

. The findings showed that this strategy demonstrated promising efficacy and relatively low rates of hepatoxicity in patients with 

 G12C–positive non–small cell lung cancer (NSCLC).

Across all treated patients (n = 58), the objective response rate (ORR) was 29% (95% CI, 18%-43%), comprised of 2 complete responses and 15 partial responses, and the disease control rate was 83% (95% CI, 71%-91%). The median duration of response was 17.9 months (95% CI, 5.6-not evaluable). Of note, responses were similar in immunotherapy-pretreated and -naïve patients. Overall survival with any sotorasib/PD-1 inhibitor combination was 15.7 months (95% CI, 9.8-17.8).

Due to the durable efficacy and safety of low-dose sotorasib as lead-in therapy followed by concurrent use with pembrolizumab, this regimen will be studied further as frontline treatment in patients with 

 by the FDA as monotherapy for patients with previously treated 

 G12C–mutant NSCLC as determined by an FDA-approved test based on results from the 

 Preclinical evidence has suggested that PD-1 inhibition may synergize with sotorasib to enhance CD8-positive T-cell infiltration and inhibit tumor growth.

In the current analysis, patients from the phase 1/2 CodeBreak 100 and CodeBreak 101 (NCT04185883) trials who were administered sotorasib plus either atezolizumab or pembrolizumab were examined for efficacy and safety. The primary end point was 

 with secondary outcomes of ORR, duration of response (DOR), disease control rate (DCR), and pharmacokinetics.

Patients (N = 58) were included if they had advanced 

 G12C–mutated NSCLC, received or refused prior standard therapy, no prior experience with a KRAS G12C inhibitor, and no active brain metastases. All participants were randomized to an oral daily dose of sotorasib ranging from 120 mg to 960 mg. Half of the patients were first treated with a 21- or 42-day lead-in of sotorasib followed by treatment in combination with atezolizumab at 1200 mg (n = 10) or pembrolizumab at 200 mg (n = 19) every 3 weeks; the other half were treated with combination therapy of atezolizumab/sotorasib (n = 10) or pembrolizumab/sotorasib (n = 19) from the outset.

The median patient age was 66 years (range, 29-86), most had a history of smoking (93%), and the median number of prior therapies was 1 (range, 0-7). There were 12 patients (21%) who were receiving the combination as frontline therapy and 39 (67%) had been previously treated with an anti–PD-1/L1 agent. Most patients had an ECOG performance score of 1 (81%), 31% had brain metastases, and 26% had liver metastases. PD-L1 expression was under 1% in 10 patients (17%), between 1% and 49% in 16 (28%), and 50% or above in 21 (36%); the PD-L1 expression status was unknown for 11 patients.

For the patients who received concurrent pembrolizumab, sotorasib resulted in a high rate of hepatotoxic events, most of which were from liver enzyme elevation. Grade 3 hepatotoxicity across dose levels occurred at a rate of 80% in the 120 mg group (n = 5), 75% in the 360 mg group (n = 8), 100% in the 720 mg group (n = 2), and 75% in the 960 mg group (n = 4). Although sample sizes were small, lower starting doses of sotorasib trended toward fewer events of enzyme elevation leading to experimentation with the sotorasib lead-in dosing strategies.

For patients receiving pembrolizumab and a safety lead-in of sotorasib, grade 3 or greater treatment-related AEs (TRAEs) occurred in 100% of those in the 120 mg group (n = 3), 20% in the 240 mg group (n = 5), and 55% on the 360 mg group (n = 11). The rate of grade 3 hepatotoxicity in each respective group was 67%, 20%, and 45%. Overall safety data from both the lead-in and concurrent administration groups suggested a lower starting dose of sotorasib and lead-in administration is preferable for better tolerability.

Looking at all treatment arms, lead-in treatment strategies resulted in fewer overall and grade 3/4 TRAEs, discontinuations, and hepatotoxicity vs concurrent therapy. The first occurrence of grade 3/4 hepatotoxicity was outside the dose-limiting toxicity window in 88% of patients with 97% of cases resolving with corticosteroids or treatment modification and/or discontinuation. Notably, pretreatment with immunotherapy did not appear to influence the rate of treatment-related hepatotoxicity.

For the patients treated with atezolizumab/sotorasib, grade 3/4 TRAEs occurred at rates of 30% and 0% in those treated with lead-in therapy vs 50% and 10%, respectively, with the combination. Treatment discontinuation of either atezolizumab or sotorasib due to TRAEs occurred in 10% of those treated with lead-in therapy vs 50% on a concurrent regimen. Median treated duration was longer in the lead-in group at 6.5 months (range, 1-18) vs 4.4 months (range, 1-14) with concurrent therapy, whereas the median duration of combination therapy specifically was shorter at 1.5 months (range, 0-18) vs 2.5 months (range, 1-14), respectively. Median onset of hepatoxicity was shorter with the lead-in regimen at 50 days (range, 28-93) vs 67 days (range, 36-147) with concurrent treatment.

For the patients treated with pembrolizumab/sotorasib, grade 3/4 AEs occurred at rates of 53% and 0% in those treated with lead-in therapy vs 74% and 5%, respectively, with the combination. Treatment discontinuation of either atezolizumab or sotorasib due to TRAEs occurred in 32% of those treated with lead-in therapy vs 53% on a concurrent regimen. Median treatment duration was longer in the lead-in group at 2.8 months (range, 1-15) vs 4.9 months (range, 2-30) with concurrent therapy, whereas the median duration of combination therapy specifically was shorter at 0.7 months (range, 1-15) vs 2.3 months (range, 1-9), respectively. Median onset of hepatoxicity was shorter with the lead-in regimen at 73 days (range, 45-127) vs 51 days (range, 29-190) with concurrent treatment.

Li BT, Falchook GS, Durm GA, et al. CodeBreaK 100/101: first report of safety/efficacy of sotorasib in combination with pembrolizumab or atezolizumab in advanced 

 p.G12C NSCLC. Presented at: 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria. Abstract OA03.06.

FDA grants accelerated approval to sotorasib for KRAS G12C mutated NSCLC. News Release. FDA. May 28, 2022. Accessed August 7, 2022. https://bit.ly/3Q7hDff

Canon J, Rex K, Saiki AY, et al. The clinical KRAS(G12C) inhibitor AMG 510 drives anti-tumour immunity. 

. 2019;575(7781):217-223. doi:10.1038/s41586-019-1694-1

Sotorasib is often associated with a high rate of hepatotoxic events, most of which are from elevated liver enzymes. However, a lead-in dosing strategy may help address this adverse event and improve patient tolerability. 

Experimental Dosing Strategy With Sotorasib Plus Immunotherapy Helps Combat Hepatotoxicity in KRAS G12C+ NSCLC

Survival rates for patients with lung cancer have improved significantly since the advent of immunotherapy, according to Michelle M. Turner, MS, CRNP. However, because of these new advances, there is now a growing population of survivors whose long-term care needs are not well understood.

Because of improvements in lung cancer screening, and developments in targeted and immunotherapies, approximately 20% of patients with lung cancer are expected to survive at least 5 years past diagnosis and the number of survivors is expected to continue to grow by 60,000 individuals annually.

, Turner, who is a nurse practitioner at Johns Hopkins Sydney Kimmel Cancer Center, presented findings from a study which interviewed patients with non–small cell lung cancer (NSCLC) about their long-term experiences with immunotherapy.

“We have really changed the trajectory of our patient’s overall survival, but we don’t know how to take care of them quite as well as we did prior,” Turner said, adding, “little is known about the longitudinal physical, emotional, and financial needs of this population.”

The study involved interviewing patients with pathologically confirmed, locally advanced or metastatic NSCLC who had undergone treatment with immune-checkpoint inhibitors and had survived their first year on this therapy. The interviews were conducted both in-person and over the telephone. A retrospective chart review was used to gather demographic information.

Interviews were transcribed and thematic analysis were performed using a constant comparative methodology to refine themes into a finalized coding scheme. The results included interviews from 10 patients who were NSCLC survivors. Four of these patients were men and 6 were women. Age at time of diagnosis ranged from 63 to 72 years. Eight patients were Caucasian, 1 was African American, and 2 were Mediterranean. Six patients had metastatic disease, 3 had metastatic recurrence, and 1 had locally advanced disease.

Turner acknowledged that there are multiple definitions of survivorship; however, the one she prefers and the one which guided this research is the American Society of Clinical Oncology definition: “The time period between a new [diagnosis of] cancer, followed by the duration of life during and after cancer therapy.”

One of the most prominent themes which many patients echoed was an inability to recall their treatment education. Because lung cancer is associated with a poor prognosis, patients responded that they felt too overwhelmed to process what their providers were attempting to teach them about immunotherapy.

One example of a response from a patient said: “[My physician] explained this immunotherapy and what it was, and I had no idea what she was talking about to be honest with you.”

“We really have to be cognizant when we’re talking to our patients, about our treatments, and that they really understand what is going on,” Turner said.

Similarly, many patients expressed a sense of acceptance of death along with their diagnosis. Some patients reported having paid for their funeral and their house and making other end-of-life preparations. At the same time, for many, news of their diagnosis brought a sense of risk taking and courage: patients were willing to try the unknown, such as experimental treatments, because they equated this with not giving up, even if they were facing potentially severe adverse event (AE) profiles.

In terms of emotional toxicity, guilt and worry were 2 feelings which taxed patient functions and socialization. Although these emotions reportedly waxed and waned throughout the cancer journey, they were described to be long-term toxicities which affected them beyond treatment.

“Occasionally… I’m asked to talk with someone who has cancer,” said one patient. “Sometimes I feel a little bad about it, because certainly I can listen to them, I can offer them hope, but I can’t offer them the kind of miracle that I had. I know that no matter how encouraging I am, the statistical odds are that they won’t be quite as fortunate as I’ve been.”

Another theme which emerged was the sources of support and strength. Participants named numerous sources from which they gain strength, including internal factors such as spirituality, self-reliance, and exercise, and external factors such as family and friends.

“I don’t think I could have had sch a positive outlook without my family around,” one patient shared. “I had a sister that watched me like a baby. And a husband who did the same… I just had a lot of support… I don’t know how people do this without other people.”

In a similar vein, results showed that many of the physical toxicities experience by patients took a toll on their social and emotional well-being. For example, many patients experienced issues with intimacy following sexual dysfunction, and some patients shared that they were afraid to go out in public because of gastrointestinal issues.

“We don’t [necessarily] realize how challenging that is,” Turner said. She shared that many patients may feel as though these complications are simply the price to pay for survivorship, but she disagrees. “[They will say]: Well, I should be happy, I’m alive. And while that’s important, their quality of life is also important,” she said.

Other physical toxicities in later survivorship include generalized fatigue, respiratory issues, dermatologic, neurologic, and endocrine issues, as these all play a role in quality of life, Turner said.

Financial concerns represented another major theme. The main stressors associated with financial concerns for patients included out of pocket costs, the role of insurance, and unemployment throughout cancer care.

One patient shared that they had to empty their IRA to pay for their treatments: their cyberknife laser therapy was $28,000 without treatment, and in total, they owed over $320,000 in hospital bills, but they have since stopped paying attention to what they owe.

“[When considering] all of these toxicities that these patients are experiencing, [ask] are these emotional challenges?” Turner said. “How do they get back into the workforce if they’ve taken time off? We have to support them in different ways.”

Finally, surveillance represented a significant unanswered question for many NSCLC survivors. Many participants noted that they went to a primary care provider for longitudinal follow-up care but were unsure whether these generalists would be able to properly address their specific needs—particularly long-term immunotherapy symptoms.

“We have a lot of work to do,” Turner summarized, stating that identifying the physical, social, emotional, and medical needs of patients 5 years beyond treatment remains a challenge for providers.

“Survivorship programs have to be personalized based on our institution, based on our provider-patient relationship, to see what the needs of our patients and support services in place are,” she concluded. “This is not a one man show: we have to get engage social work, psychiatry, clergy, financial counselors, palliative care, the list goes on. [Although] it’s important to take care of their medical needs, there is a whole different level we have to focus on as well.”

Turner MM. Long-term immunotherapy survivors of advanced NSCLC: the survivorship experience. Presented at the 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria. Abstract ES31.03

A study presented at the 2022 World Conference on Lung Cancer explored the experiences of patients who received checkpoint inhibition therapy for non–small cell lung cancer.

NSCLC Survivors Highlight Unmet Needs in Long-Term Experiences With Immunotherapy

Positive survival outcomes among patients with treatment-naive extensive-stage small cell lung (ES-SCLC) cancer were observed after approximately 3.5 years of follow-up following treatment with pembrolizumab (Keytruda) and etoposide, according to data from the phase 3 KEYNOTE-604 trial (NCT03066778) presented at the 

The 36-month overall survival (OS) rate in the pembrolizumab arm was 15.5% compared with 5.9% (HR, 0.76; 95% CI, 0.63-0.93) in the placebo arm, reducing the risk for death by 24%. Moreover, median OS was 10.8 months (95% CI, 9.2-12.9) with pembrolizumab compared with 9.7 months (95% CI, 8.6-10.7) with placebo.

Additionally, the 36-month progression-free survival (PFS) rate was 6.9% in the pembrolizumab arm vs 0.5% in the placebo arm (HR, 0.70; 95% CI, 0.57-0.85). The median PFS was 4.8 months (95% CI, 4.3-5.4) with pembrolizumab compared with 4.3 months (95% CI, 4.2-4.5) with placebo.

“[With 3.5] years of follow-up now, the patients who are on pembrolizumab continue to show clinically meaningful improvements, in particular PFS as well as OS,” Charles Rudin, MD, PhD, chief of thoracic oncology service, codirector of Druckenmiller Center for Lung Cancer Research, and Sylvia Hassenfeld Chair in Lung Cancer Research at Memorial Sloan Kettering Cancer Center, said during a presentation on the findings. “There’s [approximately] a tripling of the 3-year OS rate, [and] about a 20-fold improvement in 2-year PFS. Those patients who have completed [the] full 2 years of pembrolizumab and have durable responses, with the majority, remaining alive now with [approximately] 4 years of follow up after randomization. We need to continue to explore the benefits of immunotherapy in this patient population and see if we can build the tail of the curve to raise it up to 5 or more [years of survival].”

The study included patients with stage IV SCLC who had not previously been treated with a systemic therapy and had an ECOG performance status of 0 or 1. Patients needed to also have a sample available for biomarker analysis. Those who enrolled could not have unstable brain metastases and were required to have adequate organ function and a life expectancy of 3 months or more. Stratification factors included type of cisplatin agent, ECOG performance status, and lactate dehydrogenase level.

A total of 453 patients were randomly assigned 1:1 to receive pembrolizumab at 200 mg on day 1, plus 100 mg/m2 of etoposide on days 1 to 3, and carboplatin or 75 mg/m2 of cisplatin every 3 weeks for 4 cycles (n = 228); or the chemotherapy backbone plus placebo (n = 225). Those in the placebo arm went on to receive maintenance pembrolizumab on day 1 every 3 weeks for up to 31 cycles.

The dual primary end points were progression-free survival (PFS) and OS, with key secondary end points including overall response rate (ORR), duration of response (DOR), and safety.

In the experimental arm, a total of 18 patients completed 35 cycles of treatment with pembrolizumab and 122 went on to receive a subsequent therapy. Fifteen patients received treatment with a subsequent immune checkpoint inhibitor. In the placebo group, 2 patients completed treatment and 220 discontinued due to progressive disease (n = 196), adverse events (AEs; n = 13), consent withdrawal (n = 7), physician decision (n = 3), and protocol violation (n = 1). The median time from randomization to cutoff was 43.3 months.

The median age in the pembrolizumab group was 64.0 years vs 65.0 years in the placebo group, and the majority of patients in both arms were men. Most patients in both the pembrolizumab and placebo cohorts had an ECOG performance status of 1 (73.7% vs 75.1%, respectively) and were current or former smokers (96.5% vs 96.4%). Additionally, 70.6% and 69.3% of patients in both respective cohorts had received treatment with carboplatin.

The overall response rate in the pembrolizumab arm was 70.6% (95% CI, 64.2%-76.4%) vs 61.8% (95% CI, 55.1%-68.2%) in the placebo cohort. Among those in the experimental arm, 2.2% experienced a complete response (CR), 68.4% achieved a partial response, 17.5% had stable disease, and 3.5% had progressive disease. Additionally, the DOR rates at 12, 24, 36, and 42 months or more were 20.7%, 14.6%, 11.5%, and 10.1%, respectively. In the placebo arm, the CR rate was 0.9%, the PR rate was 60.9%, the stable disease rate was 24.9%, and the progressive disease rate was 5.3% The DOR rates at 12, 24, 36, and 42 months or more were 3.3%, 0.8%, 0.8%, and 0.8%, respectively.

All patients in the pembrolizumab arm experienced any-grade of AE and 78.9% experienced grade 3 to 5 AEs. Additionally, 15.7% of patients had AEs that led to discontinuation of any treatment, 4.0% had AEs that led to discontinuation of all treatment, and 6.3% had AEs that led to death. Immune-mediated AEs occurred in 27.4% of patients within this group, 8.1% of which were grade 3 to 5. Additionally, 0.4% of patients in this cohort had grade 3/4 infusion reactions.

In the placebo cohort, 99.6% of patients had any-grade AEs and 77.1% had grade 3 to 5 AEs. In this population, 6.3% of patients had AEs that led to discontinuation of any treatment, 3.6% had AEs that led to discontinuation of all treatments, and 5.4% had AEs that led to death. Immune-mediated AEs were reported in 12.1% of patients, 1.3% of which were grade 3 to 5.

Previous findings from the study indicated that the 12- and 24-month OS rates for patients in the pembrolizumab arm were 45.1% and 23.0%, respectively, compared with 39.6% and 12.7% in the placebo arm. The PFS rate at 12 months and 24 months in the pembrolizumab arm was 17.1% and 11.1%, respectively, vs 5.0% and 0.5% in the placebo arm.

Rudin CM, Kim HR, Navarro A, et al. First-line pembrolizumab or placebo combined with etoposide and platinum for ES-SCLC: KEYNOTE-604 long-term follow-up results. Presented at the 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria. Abstract 1849.

Patients with treatment-naive extensive-stage small cell lung cancer showed encouraging clinical responses with pembrolizumab and etoposide after multiple years of follow-up.

3.5-Year Follow-Up Finds Pembrolizumab/Etoposide Combo Still Effective in Untreated ES-SCLC

A trend in overall survival (OS) improvement was observed among patients with resected non–small cell lung cancer (NSCLC) who were treated with atezolizumab (Tecentriq) vs best supportive care, according to phase 3 findings from the IMpower010 trial (NCT02486718).

showed that at a median follow-up of 46 months the median OS in patients with PD-L1 expression of at least 1% was not reached in the atezolizumab group (n = 248) or best supportive care group (n = 228; HR, 0.71; 95% CI, 0.49-1.03). Moreover, the OS rates at 36 months and 60 months were 82.1% and 76.8% in the atezolizumab group, respectively, compared with 78.9% and 67.5% in the best supportive care group.

In all patients who were randomized to treatment, the median OS was not reached in the atezolizumab (n = 442) and best supportive care groups (n = 440; HR, 0.95; 95% CI, 0.74-1.24), respectively. OS events occurred in 26.0% and 26.4% of patients in each respective group. In the intent-to-treat (ITT) population, the median OS was also not reached in either the atezolizumab (n = 507) or best supportive care (n = 498) cohorts (HR, 0.995; 95% CI, 0.78-1.28; 

 = .9661). OS events were reported in 25.0% and 24.9% of patients in each group, respectively.

Further, the investigators conducted a subgroup analysis in patients with PD-L1–positive stage II/IIIA disease.

“We performed the subgroup analysis of OS…there is a trend towards an improvement in [OS] for those patients receiving atezolizumab,” according to lead author Enriqueta Felip, MD, PhD, head of the lung cancer unit, Department of Oncology at Vall d’Hebron University Hospital. “We can see that for those patients with squamous cell carcinoma, the hazard ratio for OS was 0.85; for those patients with nonsquamous cell, it was 0.61; for those patients with pathological stage IIA [disease], the HR was 0.75; for [those with] stage IIB [disease, the HR was] 0.64; and [for] stage IIIA [disease], it was 0.70.”

The study included patients with stage IB to IIIA tumors that were 4 cm or greater who had an ECOG performance status of 0 or 1. Patients also needed to have undergone a lobectomy and have tumor tissue available for PD-L1 analysis.

Patients (n = 1280) initially received treatment with cisplatin and pemetrexed, gemcitabine, docetaxel, or vinorelbine for 1 to 4 cycles of treatment and were then randomized 1:1 (n = 1005) to either the experimental or control group. Patients in the experimental group were then treated with 1200 mg of atezolizumab every 21 days for 16 cycles or 1 year, and the placebo group received best supportive care. Patients were stratified based on sex, stage, histology, and PD-L1 status.

The primary end point was investigator-assessed disease-free survival (DFS) tested hierarchically, with secondary end points including OS in the ITT population, DFS in the PD-L1 population, and 3- and 5-year DFS. OS biomarker analyses were also performed as part of an experimental end point.

A previous readout from an interim analysis indicated that at a median follow up of 32.0 months,

 the OS data were not mature, with investigators citing an event-to-patient ratio of 19% in the ITT population and 18% in the best supportive care arm. The hazard ratios (HR) were 0.77 (95% CI, 0.51-1.17) in those with PD-L1 expression of 1% or more, 0.99 (95% CI, 0.73-1.33)

in all randomized patients, and 1.07 (95% CI, 0.80-1.42) in the ITT population.

Moreover, HRs for DFS were 0.66 (95% CI, 0.50-0.88; 

 = .0039) for the PD-L1 expression of 1% or more population, 0.79 (95% CI, 0.64-0.96; P = .0205) in the overall randomized population, and 0.81 (95% CI, 0.67-0.99; P =.0395) in the ITT population.

Additional findings from the study indicated that the OS rates at 36 months and 60 months among those with a PD-L1 expression of 50% of more who were treated with atezolizumab were 89.1% and 84.8%, respectively, vs 77.5% and 67.5% in the best supportive care arm. Median OS was not reached in either arm (HR, 0.42; 95% CI, 0.23-0.78).

Any-grade adverse events (AEs) were reported in 92.5% of patients in the atezolizumab arm and 70.9% in the best supportive care arm, of which 67.9% and 0.0%, respectively, were treatment related. Moreover, 22.0% and 11.5% of AEs in either arm were grade 3/4, 10.7% and 0.0% of which were treatment related. Investigators also reported that 7.5% of patients in the atezolizumab arm and 0.0% of those in the best supportive care arm experienced serious treatment-related AEs, and 1.8% and 0.6% had grade 5 AEs, respectively. Additionally, 28.7% and 18.2% of patients in the atezolizumab arm required a dose interruption or treatment withdrawal due to AEs vs no patients in the control group.

Felip concluded by stating the trial will be continuing to the final DFS and OS analysis.

Felip E, Altorki N, Vallieres E, et al. IMpower010: overall survival interim analysis of a phase III study of atezolizumab vs best supportive care in resected NSCLC. Presented at the 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria; PL03.09.

Felip E, Altorki N, Zhou C, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB–IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial. 2021;398(10308):1344-1357. doi:10.1016/S0140-6736(21)02098-5

Phase 3 findings from the IMpower010 trial show that patients with resected non–small cell lung cancer may achieve an overall survival benefit with atezolizumab. 

Atezolizumab Signals OS Improvement in Patients with Resected NSCLC

 fusions continued to achieve favorable responses with larotrectinib (Vitrakvi) according to data from an extended analysis of the phase 2 NAVIGATE (NCT02576431) trial and phase 1 LOXO-TRK-14001 trial (NCT02122913), presented at the 2022 World Conference on Lung Cancer.

Investigators observed an objective response rate (ORR) of 83% (95% CI, 61%-95%) in 23 evaluable patients with 

 fusion–positive disease. The 24-month progression-free survival (PFS) rate was 67% (95% CI, 44%-90%) while the 24-month overall survival (OS) rate was 72% (95% CI, 48%-97%).

“Larotrectinib demonstrated rapid and durable responses, extended survival, and a favorable long-term safety profile in patients with advanced lung cancer harboring 

 gene fusions,” the investigators stated in their poster.

NAVIGATE (NCT02576431) trial and LOXO-TRK-14001 enrolled patients with fusions in the 

 genes. Patients with cancer types including lung, thyroid, salivary, and colorectal cancers were enrolled on these trials, but this analysis included only those with advanced lung cancer. Both trials administered larotrectinib at a dose of 100 mg twice daily. The primary end point was ORR.

Larotrectinib was also investigated as an NTRK inhibitor in the SCOUT trial (NCT02637687). Across all 3 trials and disease types, this drug exhibited an overall response rate of 75% (95% CI, 61%-85%) by independent review committee (IRC) and 80% by investigator assessment (INV) in 55 patients with predominantly grade 1 adverse events (AEs).

 In 2018, based on SCOUT, NAVIGATE, and LOXO-TRK-14001, it was approved by the FDA for all solid tumors harboring an 

 fusion in adults and children with metastatic disease or those who cannot receive surgery and have no satisfactory alternative treatments.

At the previous data cutoff of July 20, 2020, 15 patients with advanced lung cancer were evaluated, with an ORR of 87% as assessed by an IRC and 73% by INV.

 With an additional year of follow-up, the ORR was still 87% by IRC, termed Group 1 in this analysis.

 They also presented data for Group 2, which consisted of these 15 plus an additional 11 patients. Both groups were evaluated at a data cutoff of July 20, 2021.

For Group 1, the median DOR was not reached; the median PFS was 33.0 months; and median OS was 40.7 months at a median follow-up of 24.0, 35.8, and 35.8 months, respectively.

Investigators found that of the 23 evaluable patients in Group 2, there were 2 complete responses, 17 partial responses (PR), and 4 patients with stable disease (SD). No patients had progressive disease. The median PFS and DOR in all 26 patients were not reached, while the median OS was 40.7 months (95% CI, 19.4–not estimable [NE]). The 24-month rate of DOR was 72%. The median follow-up for DOR was 12.9 months, while for PFS it was 14.6 months and for OS it was 12.9 months.

When including all 26 patients, the median age was 51.5 years (range, 25.0-76.0). Patients had received a median of 2 prior therapies (range, 0-6), with 46% having received 3 or more prior therapies.

Ten evaluable patients had baseline central nervous system metastases. They had an ORR of 80% (95% CI, 44%-97%) including 8 PRs and 2 with SD. For these patients, the median DOR was 9.5 months (95% CI, 3.6–NE), while the median PFS was 9.9 months (95% CI, 5.3–NE), and the median OS was 19.4 months (95% CI, 7.6–NE) at a median follow-up of 9.3, 11.0, and 12.0 months, respectively.

There were no new safety signals for Group 1, which previously reported mainly grade 1 and 2 AEs. Group 2 also reported mainly grade 1 and 2 treatment-related AEs. The most common treatment-related AEs included elevated alanine aminotransferase and aspartate aminotransferase (AST) levels (38.5% and 30.8%, respectively), followed by myalgia (26.9%) and constipation (23.1%). The most common grade 3 or higher AEs related to larotrectinib were increased AST (7.7%) and weight gain (7.7%). No patients discontinued treatment due to AEs.

These results confirm the long-term response and efficacy of larotrectinib in patients with advanced lung cancer who are identified as harboring 

 fusions. “These results support testing for 

 gene fusions in patients with lung cancer,” the investigators concluded in their poster.

1. Moreno V, Lin JJ, Tan DSW, et al. Extended follow-up of efficacy and safety of larotrectinib in patients with TRK fusion lung cancer. Presented at: IASLC 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria. Abstract EP08.020-148.

2. Drilon A, Laetsch TW, Kummar S, et al. Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N Engl J Med. 2018;378(8):731-739. doi:10.1056/NEJMoa1714448

3. FDA approves larotrectinib for solid tumors with NTRK gene fusions. FDA. December 14, 2018. Accessed August 4, 2022. https://bit.ly/3Sve4AX

4. Drilon A, Tan DSW, Lassen UN, et al. Efficacy and safety of larotrectinib in patients with tropomyosin receptor kinase fusion-positive lung cancers. JCO Precis Oncol. 2022;6:e2100418. doi:10.1200/PO.21.00418

Extended follow-up data from 2 trials confirmed that larotrectinib yielded positive progression-free and overall survival outcomes for patients with NTRK-positive lung cancer.

Larotrectinib Holds Ground as Effective Treatment in NTRK-Positive Lung Cancer

Patients with non–small cell lung cancer (NSCLC) harboring an 

mutation demonstrated encouraging responses to a novel regimen of amivantamab-vmjw (Rybrevant) in combination with lazertinib (Leclaza) plus carboplatin and pemetrexed, according to findings from the phase 1 CHRYSALIS-2 trial (NCT04077463).

In data presented at the 2022 IASLC World Conference on Lung Cancer, investigators noted that patients derived benefit from treatment irrespective of brain metastasis.

Among all patients (N = 20), the objective response rate (ORR) was 50% (95% CI, 27%-73%) with a clinical benefit rate (CBR) of 80% (95% CI, 56%-94%). In patients with baseline brain metastases (n = 10), the ORR was 50% (95% CI, 19%-81%) and the CBR was 80% (95% CI, 44%-98%).

Amivantamab is an EGFR-MET bispecific antibody with immune cell-directing activity. Lazertinib is a highly selective, brain-penetrant, third-generation EGFR TKI with efficacy in activating 

 mutations, T790M, and central nervous system disease. The study authors explained in the presentation that combining platinum-based chemotherapy with targeted inhibition of EGFR-MET signaling may lead to improved outcomes.

Patients received 240 mg of lazertinib once daily, plus 1400 mg or 1750 mg of amivantamab on days 1, 2, 8, and 15 of cycle 1; day 1 of cycle 2, and 1750 mg or 2100 mg in cycle 3, followed by every 3-week dosing intervals thereafter. Patients also received 500 mg/m2 of pemetrexed and carboplatin at an area under the curve of 5, which was stopped after 4 cycles. The dosing for amivantamab was dependent on weight of less than 80 kg or 80 kg and above.

The primary end point was safety. Other end points included ORR, duration of response (DOR), CBR, progression-free survival (PFS), and overall survival (OS).

-mutated NSCLC who had received up to 3 prior lines of therapy with a TKI. The median patient age was 61 years (range, 38-83). Most patients were female (n = 11; 55%), Asian (n = 11; 55%), and had an ECOG performance status of 1 (n = 16; 80%). Thirteen (65%) patients had an an exon 19 deletion as opposed to an L858R mutation. Half of patients had brain metastases at baseline.

The median number of prior lines of therapy was 2 (range, 1-3). Prior therapy consisted of a first- or second-generation TKI (n = 9; 45%), osimertinib (Tagrisso; n = 14; 70%), and platinum-based chemotherapy (n = 5; 25%).

At a median follow-up of 7.1 months (range, 2.4-10.4), the median number of treatment cycles was 10 (range, 2-15). The median number of cycles of carboplatin and pemetrexed were 4 and 7.5, respectively.

Additional findings attested to the durability of the regimen, with a median DOR, PFS, and OS that were not estimable. Notably, 15 of 20 patients remain on treatment, including all 10 responders.

“Individual AEs were mostly low grade, and EGFR- and MET-related AEs [adverse effects] were consistent with previously reported data on amivantamab and lazertinib,” the study authors wrote.

EGFR-specific treatment-emergent AEs (TEAEs) included rash (any grade, 75%; grade ≥3, 5%), stomatitis (any grade, 60%; grade ≥3, 0%), paronychia (any grade, 50%; grade ≥3, 0%), dermatitis acneiform (any grade, 35%; grade ≥3, 10%), and diarrhea (any grade, 25%; grade ≥3, 5%). MET-specific TEAEs included hypoalbuminemia (any grade, 15%; grade ≥3, 5%).

Other reported TEAEs included neutropenia (any grade, 85%; grade ≥3, 70%), infusion related reaction (any grade, 60%; grade ≥3, 0%), fatigue (any grade, 50%; grade ≥3, 25%), nausea (any grade, 40%; grade ≥3, 0%), thrombocytopenia (any grade, 40%; grade ≥3, 25%), constipation (any grade, 35%; grade ≥3, 0%), decreased appetite (any grade, 35%; grade ≥3, 5%), anemia (any grade, 25%; grade ≥3, 5%), epistaxis (any grade, 25%; grade ≥3, 0%), hemorrhoids (any grade, 25%; grade ≥3, 0%), leukopenia (any grade, 25%; grade ≥3, 15%), dyspepsia (any grade, 20%; grade ≥3, 0%), insomnia (any grade, 20%; grade ≥3, 0%), pulmonary embolism (any grade, 20%; grade ≥3, 5%), vomiting (any grade, 20%; grade ≥3, 0%), weight decrease (any grade, 20%; grade ≥3, 0%), back pain (any grade, 15%; grade ≥3, 0%), COVID-19 (any grade, 15%; grade ≥3, 0%), dizziness (any grade, 15%; grade ≥3, 0%), hypomagnesemia (any grade, 15%; grade ≥3, 0%), hyponatremia (any grade, 15%; grade ≥3, 5%), paresthesia (any grade, 15%; grade ≥3, 0%), and peripheral edema (any grade, 15%; grade ≥3, 0%).

There were no cases of pneumonitis or interstitial lung disease. However, there was 1 fatality that was not attributed to any of the study drugs.

Investigators will further evaluate the quadruplet for patients with NSCLC in the ongoing phase 3 MARIPOSA study (NCT04988295) in patients who have received prior osimertinib. The combination of amivantamab and chemotherapy is being evaluated in NSCLC in the ongoing phase 3 PAPILLON study (NCT04538664) in patients with 

Marmarelis M, Lee SH, Spira AI, et al. Amivantamab and lazertinib in combination with platinum-based chemotherapy in relapsed/refractory 

-mutant NSCLC. Presented at: 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria; Abstract MA07.04.

Phase 1 findings showed a 50% overall response rate among patients with EGFR-mutated non–small cell lung cancer who received amivantamab in combination with lazertinib plus carboplatin and pemetrexed.

Amivantamab/Lazertinib/Chemo Regimen Gains Traction in EGFR-Mutant NSCLC

Phase 3 data demonstrated that previously treated patients with non–small cell lung cancer (NSCLC) experienced longer overall survival (OS) with second- or third-line tislelizumab (BGB-A317) vs with docetaxel, according to a presentation at the International Association for the Study of Lung Cancer (IASLC) 

In the phase 3 RATIONALE-303 trial (NCT03358875), the median follow-up time for the tislelizumab arm was 16.0 months and 10.7 months for the docetaxel arm. The median OS for patients in the intention-to-treat (ITT) population administered tislelizumab (n = 535) was 16.9 months (95% CI, 15.2-19.1) compared with 11.9 months (95% CI, 9.6-13.5) for patients who received docetaxel (n = 270; HR, 0.66; 95% CI, 0.56-0.79; 

 < .0001). The 12- and 24-month OS rates for tislelizumab were 62.1% and 36.8%, respectively, and 49.7% and 23.7%, respectively, for docetaxel.

Patients with PD-L1 expression of at least 25% of tumor cells (PD-L1 positive) treated with tislelizumab (n = 227) had a median OS of 19.3 months (95% CI, 16.5-22.6) vs 11.5 months (95% CI, 8.2-13.5) with docetaxel (n = 116; HR 0.53; 95% CI, 0.40-0.70; 

 < .0001). The 12- and 24-month OS rates were 67.4% and 42.3%, respectively, for patients in the tislelizumab arm compared with 47.8% and 22.3%, respectively, for patients in the docetaxel arm.

The previously reported interim analysis of RATIONALE-303 showed that tislelizumab significantly prolonged OS vs docetaxel leading to the agent’s approval in China in January 2022 for patients with advanced NSCLC who experienced disease progression after chemotherapy.

RATIONALE-303 enrolled adult patients aged at least 18 years with histologically confirmed, locally advanced, or metastatic squamous or nonsquamous NSCLC. Patients were required to provide fresh or archival tumor tissue samples for PD-L1 evaluation, have an ECOG performance status of 0 or 1, have acceptable hematologic and end-organ function, and have a life expectancy of more than 12 weeks.

Key exclusion criteria included prior treatment with docetaxel or a PD-1, PD-L1, or CTLA-4 inhibitor; the presence of 

 aberrations; a history of severe hypersensitivity reactions to other monoclonal antibodies; or a history of interstitial lung disease.

The trial randomized 805 patients 2:1 to receive 200 mg of intravenous (IV) tislelizumab every 3 weeks or 75 mg/m2 of IV docetaxel every 3 weeks.

OS in the PD-L1–positive and ITT populations served as the trial’s coprimary end points. Secondary end points included objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), health-related quality of life, and safety.

Study authors noted that baseline demographics and disease characteristics were representative of the target population, and they were well balanced between both arms, including for PD-L1 expression and histology.

Additional data showed that patients in the ITT population treated with tislelizumab experienced a median PFS of 4.2 months (95% CI, 3.9-5.5) compared with 2.6 months (95% CI, 2.2-3.8) for patients given docetaxel (HR, 0.63; 95% CI, 0.53-0.75). Among PD-L1–positive patients, the median PFS with tislelizumab was 6.5 months (95% CI, 6.2-8.3) vs 2.4 months (95% CI, 2.1-4.1) with docetaxel (HR, 0.37; 95% CI, 0.28-0.49).

The ORR in the ITT population was 22.6% and 7.0% for the tislelizumab and docetaxel arms, respectively. In PD-L1–positive patients, the ORR was 37.4% and 6.9% for tislelizumab and docetaxel, respectively. The median DOR in the ITT population was 13.5 months (95% CI, 8.5-19.6) for tislelizumab compared with 6.0 months (95% CI, 2.1-7.2) for docetaxel. The DOR in the PD-L1–positive population was 11.9 months (95% CI, 8.3-19.6) for tislelizumab and 4.2 months (95% CI, 0.6-6.1) for docetaxel.

A post-hoc biomarker analysis showed that patients with 

 mutations treated with tislelizumab (n = 26) had a median OS of 24.7 months (95% CI, 14.2–not applicable [NA]) compared with 7.7 months (95% CI, 3.3-14.3) in patients with 

 mutations given docetaxel (n = 15; HR, 0.22; 95% CI, 0.10-0.49; 1-sided stratified log-rank 

 = .0002). For patients who did not harbor 

 mutations, the median OS for those treated with tislelizumab (n = 218) was 15.7 months (95% CI, 13.9-17.9) compared with 12.9 months (95% CI, 10.4-14.9) for those administered docetaxel (n = 101; HR, 0.75; 95% CI, 0.57-0.99; 

 mutations who received tislelizumab had a median PFS of 14.1 months (95% CI, 6.2-NA) compared with 2.6 months (95% CI, 2.0-4.1) for those who received docetaxel (HR, 0.17; 0.08-0.37; 

mutations, tislelizumab elicited a median PFS of 4.1 months (95% CI, 2.2-6.2) vs 3.3 months (95% CI, 2.1-4.1) for docetaxel (HR, 0.72; 95% CI, 0.55-0.95; 

Though tumor mutational burden was associated with a PFS benefit for patients treated with tislelizumab vs docetaxel, it was not correlated with an OS benefit, except at the highest cutoff of at least 14 mutations per megabase.

As of the July 25, 2021, data cutoff, 66 patients in the tislelizumab arm and 3 patients in the docetaxel arm were still on treatment. In the tislelizumab group, reasons for discontinuation included radiographic disease progression (n = 229), loss of clinical benefit (n = 121), adverse effects (AEs; n = 61), patient withdrawal (n = 19), clinical progressive disease (n = 23), physician decision (n = 9), concurrent antineoplastic therapy (n = 1), lost to follow-up (n = 2), and other (n = 3).

Reasons for discontinuation in the docetaxel group included radiographic disease progression (n = 168), AEs (n = 32), patient withdrawal (n = 28), clinical progressive disease (n = 15), physician decision (n = 10), concurrent antineoplastic therapy (n = 1), and protocol deviation (n = 1).

No new safety signals were reported in the final analysis. Any-grade treatment-emergent AEs (TEAEs) occurred in 96.8% of patients given tislelizumab compared with 98.4% of patients given docetaxel. The rates of grade 3 or higher TEAEs were 42.1% and 74.8%, respectively.

Common TEAES of any grade included increased ALT (20.6% and 15.1% in the tislelizumab and docetaxel arms, respectively), increased AST (19.5% and 12.4%), decreased weight (16.1% and 11.6%), cough (21.3% and 15.5%), anemia (29.2% and 44.6%), and decreased appetite (16.5% and 24.0%).

Zhou C, Huang D, Fan Y, et al. Tislelizumab versus docetaxel in previously treated advanced non-small cell lung cancer: final analysis of RATIONALE-303. Presented at: International Association for the Study of Lung Cancer 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria. Abstract EP08.01-014.

China NMPA approves tislelizumab as second- or third-line treatment for patients with locally advanced or metastatic non-small cell lung cancer. News release. Beigene. January 6, 2022. Accessed August 5, 2022. 

Comparison of efficacy and safety of anti-PD-1 antibody BGB-A317 versus docetaxel as treatment in second- or third-line setting in participants with NSCLC. ClinicalTrials.gov. Updated June 27, 2022. Accessed August 5, 2022. 

https://clinicaltrials.gov/ct2/show/NCT03358875

Patients with previously treated non–small cell lung cancer experienced a median overall survival of 16.9 months with second- or third-line tislelizumab vs 11.9 months with docetaxel. 

Tislelizumab Maintains Superior Overall Survival Benefit Vs Docetaxel in Pretreated NSCLC

Treating patients with resectable pleural mesothelioma with neoadjuvant cisplatin-pemetrexed plus atezolizumab (Tecentriq), followed by maintenance atezolizumab may be safe and effective, according to an updated analysis of the ongoing S1619 trial presented at the 2021 IASLC World Conference on Lung Cancer.

“When we speak about mesothelioma that is potentially surgically resectable, that is the patient population that we sort of consider potentially curable, although we know that recurrences occur,” explained Boris Sepesi, MD, The University of Texas MD Anderson Cancer Center. “The median survival in patients who undergo multimodality therapy that includes surgery range in different studies between 17 and 25 months… The aim of this study was really to test chemotherapy plus immunotherapy in surgically resectable mesothelioma based on the fact that these are occasionally immunogenic tumors that express PDL1 expression, which is associated with worse outcomes.”

The study sought to assess whether adding anti-PD-L1 inhibitors to neoadjuvant cisplatin-pemetrexed, followed by maintenance immunotherapy after surgical resection and adjuvant radiation would enhance T-cell activation against microscopic disease and potentially increase overall survival (OS) in patients with malignant pleural mesothelioma.

Overall, 21 patients successfully completed neoadjuvant therapy, although 7 were unable to proceed to surgical resection. Of those 7, 2 patients reported severe toxicity, 4 experienced disease progression, and 1 death occurred due to non-immune related renal and respiratory failure.

There were 18 patients with stable disease or partial response who were able to receive surgical resection, and 16 patients registered to receive maintenance atezolizumab for 1 year. Thus far, median progression-free survival is 18 months and OS has not been reached.

Participants were evaluable if they had received at least 2 cycles of the triplet neoadjuvant therapy, were chemo-naïve, had mesothelioma, and extended surgical staging. A total of 28 patients were screened between November 2017 and May 2020 with the intention of obtaining 24 eligible patients.

Patients were then administered the triple-combination regimen with the following dosage: 75 mg/m2 cisplatin, 500 mg/m2 pemetrexed, and 1200 mg IV atezolizumab every 3 weeks. As long as patients did not experience disease progression, they continued to resectable surgery. Following surgery, they were to be treated with 1 year of maintenance atezolizumab.

Within this pool of potential participants, 25 received at least 2 cycles of neoadjuvant cisplatin-pemetrexed-atezolizumab.

The median age of participants was 68 years. The majority of participants were Caucasian, and the patient pool was predominantly male. Four patients planned on receiving

extrapleural pneumonectomy (EPP) surgery, while 24 planned on receiving pleurectomy and decortication surgery (P/D).

The primary end point of the trial was to assess the safety and tolerability profiles, as well as better understand the feasibility, of 

neoadjuvant cisplatin-pemetrexed-atezolizumab treatment followed by surgery and maintenance atezolizumab. For the treatment to be considered safe or tolerable, there would be no reported grade 4 or 5 immune-related adverse events (irAEs). To be considered feasible, 75% of patients (18/24) needed to complete at least 1 dose of maintenance therapy.

The final analyses will separately assess patients who received EPP surgery and those who received P/D surgery for their resectable operation. Of the 18 that successfully received resection surgery, 17 received P/D and 1 received EPP. So far, 16 patients have registered to receive maintenance atezolizumab for 1 year. There are still 3 patients undergoing treatment with maintenance atelozimab therapy.

Investigators concluded that the triplet combination appeared to be reasonably tolerated in the patient population. There was only 1 patient who reported grade 4 or 5 AEs. Notably, that patient did experience multiple grade 4 AEs and 1 grade 5 AE. That patient experienced severe acute renal injury, sepsis, pneumonitis, and respiratory failure.

Updates from the ongoing S1619 trial suggest that a triplet combination regimen of neoadjuvant cisplatin, pemetrexed, and atezolizumab is effective and tolerable in the treatment of patients with resectable pleural mesothelioma. 

IASLC World Conference on Lung Cancer