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

Patient Accrual Will Be Harder

It's going to be much harder to conduct clinical trials comparing immunotherapy with chemotherapy if patients won't accept being randomly assigned to what might be the chemotherapy arm, Dr Bernicker said.

"I have found it harder recently to convince patients to go on to trials where the randomization was between chemo and chemo/immunotherapy," he said. "In the future we'll see more patients preferring to get the less toxic alternative, and some important trials might be slower to accrue."

"No patient wants to be randomized to a topotecan standard-of-care arm in small cell lung cancer; there's no tail [to the survival curve] and the responses are not great," Dr Bernicker continued. "The more success we see from immune therapy, the harder it's going to be to randomize patients. Cooperative groups and pharma are going to have to be very clever in how they design these trials."

Dr Bernicker said this emphasizes the importance of developing effective biomarkers.

"If we really feel that a patient is unlikely to respond to an immune checkpoint inhibitor, we can guide them on to combinations of immunotherapies or immunotherapy with chemo or radiotherapy," he said.

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Cite this: Immunotherapy 'Plus': Adding Radiation and Chemo to Immune Therapies - Medscape - Jun 27, 2016.