Immunotherapy 'Plus': Adding Radiation and Chemo to Immune Therapies

Robert H. Carlson, MBA

Disclosures

June 27, 2016

In This Article

The Search for Good Biomarkers

Dr Bernicker predicted that soon "there will be a tsunami of reports on immunotherapies used in multiple stages and tumor types, and so we really have to be looking at validating biomarkers and figuring out which patients will be having these great responses to immunotherapy monotherapy and who we may have to think about in a different way, perhaps treating with chemotherapy first or radiation added."

There are strong hints that in certain tumor types, higher tumor expression of PD-L1 often does correlate with response to a PD-1 inhibitor, he said. But from the clinical side, even people who are low PD-L1 expressers do respond, pointing to immunotherapy for them as well.

"And for many cancers, such as lung, we don't have awesome second-line choices," he said. "If the patient has a fairly low PD-L1-expressing tumor and the choice is FDA-approved nivolumab or docetaxel, I can tell you which the patients will choose: They want the immunotherapy."

He believes that there will eventually be an array of biomarkers to guide management: PD-L1 expression, immune cell infiltrate, cytokine expression, mutational burden, and more.

"We're going to be much more sophisticated with this over the next number of years with the basic sciences advances," he said.

It's reasonable in clinical practice today for every patient to get access to immunotherapy at some point "because we are not good yet at picking out who the patients are," said Jason Luke, MD, an assistant professor in the melanoma and developmental therapeutics program at the University of Chicago.

"But in the future, we will know who needs PD-1 monotherapy and will do well, and who we need to do something else for, whether it be chemotherapy plus PD-1 inhibition, radiation plus PD-1, BRAF inhibitors, whatever it is."

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