Lung cancer is still the leading cause of all deaths from cancer in the country and worldwide. Many patients with lung cancers have never smoked. Fortunately, new medicines such as immunotherapies are beginning to provide hope for patients with these diseases.
Meet Dr. Matthew Hellmann. He cares for people with lung cancers, particularly non-small-cell lung cancer (NSCLC). His recent work has examined ways to improve the effectiveness of immunotherapies for these patients. We sat down with Dr. Hellmann to learn more.
First, what is non-small-cell lung cancer?
Non-small-cell lung cancer, or NSCLC, may or may not be related to smoking. Small cell lung cancer is almost exclusively related to smoking. The important differences in the genetics and clinical features of these diseases make it important that we consider them distinctly—because they might need different solutions and treatments.
Do patients with NSCLC do well with immunotherapies?
Some do, and we are continuously trying to strengthen the impact of these drugs, so more patients can benefit, and for longer periods of time.
Because MSK studies had demonstrated that melanoma patients have greater success with a combination of two immunotherapies over a single immunotherapy or chemotherapy, we set up similar trials for NSCLC patients.
What did you find, and how did this discovery shape your research?
Early on, we noticed that NSCLC patients with high tumor mutational burden (TMB), a measure of the number of mutations within a tumor genome, responded more favorably to dual immunotherapy. So we amended a study and included an analysis of TMB’s effectiveness as a biomarker—a measure that can inform and improve
treatment decisions.
Why do some people with lung cancer benefit from immunotherapy while others do not?
Answering this—and helping more patients benefit from immunotherapies—is a top priority of researchers at MSK.
We were excited to see that patients with high TMB had the best response to the combination immunotherapy (nivolumab and ipilimumab). This new finding is helping to advance the standard of care: some NSCLC patients may now be spared chemotherapy and use immunotherapy as a frontline treatment. And there may be even better biomarkers out there that we are eager to explore to maximize the precision and benefit of immunotherapy.
Where do successes like these originate, in the lab or the clinic?
Actually, it is in the intersection where they meet. By working closely with scientists, we can use their data to improve treatment. And by caring for and learning from our patients, we can bring our observations back to the lab to inform research.
It is deeply moving when you can say to someone, who had metastatic disease, you effectively don’t have cancer. And we are having more moments like these because philanthropy funds some of the most essential research at MSK.