New Paradigms in the Treatment of Mesothelioma and NSCLC: An Overview by Fred Hirsch

Dr. Haffizulla: Welcome to PracticeUpdate. I’m Dr. Farzanna Haffizulla. Joining me today is Dr. Fred Hirsch, CEO of the International Association for the Study of Lung Cancer, and Professor of Medicine at the University of Colorado in Denver. Dr. Hirsch, thank you, so much, for joining me.

Dr. Hirsch: Thank you, so much, for the invitation.

Dr. Haffizulla: You’re very welcome. Well, I want to first start off with talking about mesothelioma. Any latest advances or current treatments that have come to the forefront that have precipitated based on clinical trials recently?

Dr. Hirsch: Mesothelioma is an interesting disease where we unfortunately haven’t seen much progress, either, over a long time. Pemetrexed-platinum is a standard of care for mesothelioma, but what we have seen most recently is the introduction of immunotherapy also in this disease, and with very encouraging data. It is still very preliminary data, and certainly we need much more matured clinical trials, but already by now we can see a very clear encouraging signal with the PD-L1, PD-1 antibodies.

Dr. Haffizulla: Okay. Absolutely. Well, switching gears a little bit. I want to talk a little bit further on immunologic biomarkers, talking about neoantigen signatures and mutational load of tumors. Other than assessing or using this information to assess the severity of the disease, perhaps, or the risk of relapse and choice of agents that you would like to use in this particular patient, anything else you’d like to share on that home front?

Dr. Hirsch: Yeah, so that will probably be most related to non-small cell lung cancer. We have recently seen data in mesothelioma for follow-up on the mesothelioma stuff that mesothelioma has much less mutation burden than we see in small cell and non-small cell lung cancer, and that might be important when we are talking immunotherapy and promises, but we don’t know. We see encouraging results currently in mesothelioma with the new immune checkpoints. In non-small cell lung cancer there seems to be a relation between mutation burden and sensitivity to some of the checkpoint inhibitors, and that is interesting. On a personal level, I think we need to learn more about it because I don’t think all mutations are equal, and all mutations are not equally immunogenic, so we need to learn more about the mutation load, mutation types. Are we talking tumor heterogeneity? Are we talking trunk mutations? Are we talking branch mutations, so mutation load might be too broad in term in the future, but currently we actually see an association between mutation load and sensitivity to some of those immune checkpoints.

Source: New Paradigms in the Treatment of Mesothelioma and NSCLC: An Overview by Fred Hirsch

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