Advanced NSCLC Immunotherapy: Relapse Risk vs. Benefit
- At a recent Institute for Value-Based Medicine® event, Jonathan Thompson, MD, MS, a hematology and medical oncology specialist and associate professor at Froedtert and the Medical College of...
- Thompson underscored the importance of circulating tumor DNA (ctDNA) testing to assess minimal residual disease (MRD) and inform treatment decisions.
- This discussion is part of a six-part interview series with Dr.Thompson.
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time-Limited Immunotherapy in Advanced NSCLC: A 2-Year Approach
At a recent Institute for Value-Based Medicine® event, Jonathan Thompson, MD, MS, a hematology and medical oncology specialist and associate professor at Froedtert and the Medical College of Wisconsin in Milwaukee, outlined his practice of typically targeting two years of immunotherapy for patients with advanced non-small cell lung cancer (NSCLC) before considering discontinuation, citing durable responses observed in many patients after stopping treatment.
Thompson underscored the importance of circulating tumor DNA (ctDNA) testing to assess minimal residual disease (MRD) and inform treatment decisions. He also highlighted the necessity of complete patient counseling regarding relapse risk, potential retreatment options, financial implications, and the possibility of avoiding late-onset immune-related toxicities. Thes decisions are made collaboratively, with patients actively participating in weighing the benefits and drawbacks of continued versus discontinued therapy at the two-year mark.
This discussion is part of a six-part interview series with Dr.Thompson.
The Rationale for a 2-Year Immunotherapy Course
Traditionally, immunotherapy for advanced NSCLC was often considered a continuous treatment until disease progression or unacceptable toxicity.However, emerging evidence and clinical experience suggest that a time-limited approach, such as two years, can be effective and perhaps mitigate long-term risks and costs. Dr. Thompson’s approach reflects a growing trend toward defining treatment durations based on response and risk stratification.
The rationale behind this approach stems from observations that many patients achieve durable responses after an initial period of immunotherapy. Continuing treatment beyond this point may not provide notable additional benefit for all patients, while increasing the risk of immune-related adverse events and financial strain.
The Role of ctDNA in Guiding Discontinuation
ctDNA testing is becoming increasingly crucial in monitoring treatment response and identifying MRD. Research published in Nature Medicine demonstrates that ctDNA negativity after immunotherapy is strongly associated with prolonged progression-free survival.
Dr. Thompson utilizes ctDNA results to assess the likelihood of relapse after stopping immunotherapy. A negative ctDNA result suggests a lower risk of recurrence,supporting the possibility of safely discontinuing treatment. Conversely, a positive ctDNA result may indicate ongoing disease and warrant continued therapy or choice treatment strategies.
Patient Counseling: A Collaborative Approach
Effective patient counseling is paramount when considering immunotherapy discontinuation. Dr. Thompson emphasizes a collaborative decision-making process, ensuring patients are fully informed about the potential benefits and risks of both continuing and stopping treatment.
Key discussion points include:
- Relapse Risk: Acknowledging the possibility of disease recurrence after stopping treatment.
- Retreatment Options: Discussing available therapies should relapse occur.
- Financial Burden: