BJMO - 2023, issue Special, november 2023
J. Blokken PhD, PharmD, T. Feys MBA, MSc
Historically, surgery, with or without chemotherapy, has been the standard of care for patients with earlystage non-small cell lung cancer (NSCLC). When chemotherapy was used, a platinum-based doublet regimen has been the long-standing standard adjuvant treatment for resected patients with stage II-III disease. However, the clinical benefit that can be gained with adjuvant chemotherapy is limited, with a five-year overall survival (OS) benefit of only 5%. Moreover, despite surgery and adjuvant chemotherapy, most patients with early-stage NSCLC eventually die from disease recurrence.1 In an attempt to improve on this, several clinical trials have assessed the potential impact of integrating immunotherapy into the neoadjuvant and adjuvant treatment algorithm for patients with early-stage NSCLC.
Read moreBJMO - 2023, issue Special, november 2023
J. Blokken PhD, PharmD
Over the past decade, we have witnessed a paradigm shift in the first-line treatment of patients with advanced or metastatic clear cell renal cell carcinoma (RCC). Nowadays, the preferred first-line treatment for these patients consists of a combination of an immune checkpoint inhibitor (ICI) with a tyrosine kinase inhibitor, or dual ICI therapy. With a minimal follow-up of three years, the pivotal CheckMate 9ER trial demonstrated the superior survival and response benefits of combination therapy with cabozantinib and nivolumab over sunitinib as first-line therapy for advanced RCC patients. However, effective management strategies to deal with potential adverse events are key to maintain tolerability with cabozantinib and nivolumab treatment.
Read moreBJMO - 2023, issue Special, november 2023
A. Enguita PhD, T. Feys MBA, MSc
In recent years, immunotherapy has become a vital part of the treatment algorithm for patients with advanced gastric cancer (AGC). Initially, immunotherapy-based regimens proved their worth in (heavily) pre-treated patients. More recently, however, immune-checkpoint inhibitors (ICIs) were also introduced in the first-line treatment of advanced gastric cancer. This article provides a brief overview of the clinical trials that form the rationale for this immunotherapy-shift in the management of gastric cancer.
Read moreBJMO - 2023, issue Special, november 2023
J. Blokken PhD, PharmD, T. Feys MBA, MSc
Over the past years, immune checkpoint inhibitors (ICIs) against cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) or programmed death ligand 1 (PD-L1) have drastically changed the treatment landscape for patients with non-small cell lung cancer (NSCLC). Despite their success, a considerable proportion of patients will eventually consider ICI discontinuation due to disease progression, immune-related adverse events (irAEs) or the completion of a fixed duration course of ICIs without disease progression. Against this background, evidence is mounting that ICI retreatment could be an option for some patients. To date, however, no guidelines have been published for ICI rechallenge in lung cancer and it is still unclear which patients could benefit from a second course of ICI. In this, one needs to make a distinction between restarting the ICI without any other cancer treatment in between (retreatment) or restarting ICI after another treatment was used between the two ICI regimens (rechallenge). This is an important distinction as additional treatments may influence the homeostasis of the patients’ immune system.1,2 This article describes some of the key elements that could influence treatment outcomes upon ICI retreatment or rechallenge and addresses potential strategies for ICI rechallenge and safety management.
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