1 / 46

Expert Perspectives on Immunotherapy for NSCLC: Practical Guidance and Recommendations

Expert Perspectives on Immunotherapy for NSCLC: Practical Guidance and Recommendations. This program is supported by an educational grant from Merck and Co., Inc. About These Slides.

lblakely
Download Presentation

Expert Perspectives on Immunotherapy for NSCLC: Practical Guidance and Recommendations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Expert Perspectives on Immunotherapyfor NSCLC: Practical Guidance and Recommendations This program is supported by an educational grant fromMerck and Co., Inc.

  2. About These Slides • Please feel free to use, update, and share some or all of these slides in your noncommercial presentations to colleagues or patients • When using our slides, please retain the source attribution: • These slides may not be published, posted online, or used in commercial presentations without permission. Please contact permissions@clinicaloptions.com for details Slide credit: clinicaloptions.com

  3. Co-Chairs Leora Horn, MD, MSc, FRCPCAssociate Professor of MedicineClinical Director, Thoracic Oncology Research ProgramAssistant Vice Chairman for Faculty DevelopmentVanderbilt Ingram Cancer CenterNashville, Tennessee Melissa L. Johnson, MDAssociate Director, Lung Cancer ResearchSarah Cannon Research InstituteNashville, Tennessee

  4. Faculty Disclosures Leora Horn, MD, MSc, FRCPC, has disclosed that she has received consulting fees from AbbVie, Bayer, Bristol-Myers Squibb, Genentech, Lilly, and Merck and fees for non-CME/CE services from Xcovery. Melissa L. Johnson, MD, has disclosed that she has received consulting fees from AbbVie, Celgene, and Genentech and funds for research support from Array, AstraZeneca, BerGenBio, Checkpoint Therapeutics, EMD Serono, Genmab, Genentech/Roche, Janssen, Kadmon, Lilly, Mirati Therapeutics, Novartis, OncoMed, Pfizer, Regeneron, and Stemcentrx.

  5. Outline • Overview of the Treatment of Advanced NSCLC • Clinical Application of Immunotherapy for Advanced NSCLC • Newly Diagnosed Disease • Progressive Disease • Management of Treatment-Related Adverse Events • Emerging Therapeutic Strategies With Immune Checkpoint Inhibitors

  6. Overview

  7. Lung Cancer Remains a Major Global Health Burden • One of the most common cancers and leading cause of cancer deaths in US and worldwide[1,2] • New cases, 2017 (estimated): US, 222,500; global, 1.8 million • Deaths, 2017 (estimated): US, 155,870; global, 1.6 million • ~ 80% to 85% of cases are NSCLC (~ 184,000)[3] • Stage IV at diagnosis: ~ 57%[4] • Represented by multiple disease subtypes[5] • Standard of care for stage IV NSCLC: systemic therapy 1. GLOBOCAN Cancer Fact Sheets. 2012. 2. Siegel RL, et al. CA Cancer J Clin. 2016;66:7-30. 3. American Cancer Society. Non-small-cell Lung Cancer. 4. SEER Cancer Statistics Review, 1975-2002. 5. Li T, et al. J Clin Oncol. 2013;31:1039-1049. Slide credit: clinicaloptions.com

  8. What Tools Can Facilitate Personalized Therapy in Advanced-Stage NSCLC? • How do we optimize therapy in individual pts (ie, first line, second line, third line)? Chemotherapy Targeted Therapy Checkpoint Inhibitors Histologic subtyping for chemotherapy • Genomics-driven TKIs: • EGFR • ALK • ROS1 Anti–PD-1 Anti–PD-L1 Anti–CTLA-4 Slide credit: clinicaloptions.com

  9. CTLA-4 and PD-1/PD-L1 Checkpoint Blockade for Cancer Treatment Priming phase (lymph node) Effector phase (peripheral tissue) T-cell migration Dendritic cell Cancer cell T-cell T-cell MHC TCR MHC PD-1 mAbs: Nivolumab Pembrolizumab PD-L1 mAbs: Atezolizumab Avelumab Durvalumab TCR CD28 Dendritic cell T-cell CTLA-4 mAbs: Ipilimumab Tremelimumab B7 PD-1 T-cell CTLA-4 Cancercell PD-L1 Ribas A. N Engl J Med. 2012;366:2517-2519. Slide credit: clinicaloptions.com

  10. Clinical Application of Immunotherapy for Advanced NSCLC

  11. Therapeutic Plateau in Metastatic NSCLCECOG 1594 1.0 Cisplatin/paclitaxel Cisplatin/gemcitabine Cisplatin/docetaxel Carboplatin/paclitaxel 0.8 0.6 OS (%) 0.4 0.2 0 0 5 10 15 20 25 30 Mos Schiller JH,et al. N Engl J Med. 2002;346:92-98. Slide credit: clinicaloptions.com

  12. KEYNOTE-024: Pembrolizumab vs CT as First-line Therapy for Advanced NSCLC • Open-label phase III trial • Primary endpoint: PFS • Secondary and exploratory endpoints: ORR, OS, DoR, and safety Stratified by ECOG PS (0 vs 1), histology (squamous vs nonsquamous), and enrollment region Pembrolizumab 200 mg IV Q3W for up to 35 cycles (n = 154) Until PD or unacceptable toxicity Pts with stage IV NSCLC and ECOG PS 0/1, no previous systemic therapy, no actionable EGFR/ALK mutations, and PD-L1 TPS ≥ 50%* (N = 305) Chemotherapy (histology based) for up to 6 cycles (n = 151) Until PD (crossover to pembrolizumab allowed) *≥ 50% tumor cell staining using 22C3 companion diagnostic IHC assay. Reck M, et al. N Engl J Med. 2016;375:1823-1833. Slide credit: clinicaloptions.com

  13. KEYNOTE-024: Survival Outcomes PFS OS 100 100 80 80 60 60 PFS (%) OS (%) 40 40 20 20 0 0 0 3 6 9 12 15 18 18 0 15 21 3 9 12 6 Mos Mos Reck M, et al. N Engl J Med. 2016;375:1823-1833. Slide credit: clinicaloptions.com

  14. CheckMate-026: Nivolumab vs CT in First-line Therapy for Advanced NSCLC • Randomized, open-label phase III trial • Primary endpoint: PFS (≥ 5% PD-L1 positive) • Secondary endpoints: PFS (≥ 1% PD-L1 positive), ORR, OS Stratified by PD-L1 expression (< 5% vs ≥ 5%) and histology (squamous vs nonsquamous) Nivolumab 3 mg/kg IV Q2W (n = 271) Until PD or unacceptable toxicity Pts with stage IV/recurrent NSCLC, no previous systemic therapy, no actionable EGFR/ALK mutations, PD-L1 expression ≥ 1%* (N = 541) Chemotherapy (histology based) for up to 6 cycles (n = 270) Until PD (crossover to nivolumab allowed) *≥ 1% tumor cell staining using 28-8 complementary diagnostic IHC assay. Socinski M, et al. ESMO 2016. Abstract LBA7_PR. Slide credit: clinicaloptions.com

  15. CheckMate-026: Survival Outcomes in Pts With ≥ 5% PD-L1 Expression 100 100 80 80 60 60 OS (%) PFS (%) Chemotherapy 40 40 Nivolumab 20 20 Nivolumab Chemotherapy 0 0 0 3 6 9 12 15 18 21 24 27 0 3 6 9 12 15 18 21 24 27 Mos Mos Socinski M, et al. ESMO 2016. Abstract LBA7_PR. Slide credit: clinicaloptions.com

  16. Blueprint PD-L1 IHC Assay Comparison Project: Phase 1 • Analytical comparison of % tumor cell staining (tumor proportion score), by case (n = 39), for each assay • Data points represent the mean score from 3 pathologists for each assay on each case • Superimposed lines/points indicate identical TPS values • No clinical diagnostic cutoff applied • Conclusion: 3 of 4 assays are analytically similar for tumor cell staining 22C3 (pembrolizumab), 28-8 (nivolumab), and SP263 (avelumab) 100 22C3 28-8 SP142 SP263 80 60 % Tumor Cell Staining 40 20 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 Cases SP142 (atezolizumab) Hirsch FR et al. J Thorac Oncol. 2017;12:208-222. Slide credit: clinicaloptions.com

  17. PD-L1 Testing in FNA and Cytology Samples in the Community Practice Setting 100 90% 82% Evaluable Samples for PD-L1 Testing 79% • 302 NSCLC specimens were analyzed retrospectively for PD-L1 expression using the 28‑8 antibody per the diagnostic label 80 75% 60 Evaluable Samples (%) 40 20 0 Excisional Core Needle FNA Other Cytology Evaluable samples, n 90 104 50 9 100 127 63 12 Samples analyzed, n Hussein M et al., CMSTO 2016. Abstract ORAL01.02 Slide credit: clinicaloptions.com

  18. CheckMate 017 and 057: Nivolumab vs Docetaxel in Previously Treated Advanced NSCLC • Open-label, randomized phase III trials • Primary endpoint: OS • Secondary endpoints: ORR, PFS, efficacy by PD-L1 expression, safety, QoL CheckMate 017: Squamous NSCLC CheckMate 057: Nonsquamous NSCLC Nivolumab 3 mg/kg IV Q2W (n = 292) Nivolumab 3 mg/kg IV Q2W (n = 135) Pts with stage IIIB/IV squamous NSCLC and ECOG PS 0-1 with failure of 1 previous platinum doublet chemotherapy (N = 272) Pts with stage IIIB/IV nonsquamous NSCLC and ECOG PS 0-1 who failed 1 prior platinum doublet chemotherapy ± TKI therapy (N = 582) Until disease progression or unacceptable toxicity Until disease progression or unacceptable toxicity Docetaxel 75 mg/m2 IV Q3W (n = 290) Docetaxel 75 mg/m2 IV Q3W (n = 137) Brahmer J, et al. N Engl J Med. 2015;373:123-135. Borghaei H, et al. N Engl J Med. 2015;373:1627-1639. Slide credit: clinicaloptions.com

  19. CheckMate 017 and 057: OS With a Minimum 2-Yr Follow-up CheckMate 017: Squamous CheckMate 057: Nonsquamous 100 100 80 80 60 60 OS (%) OS (%) 40 40 Nivolumab Nivolumab 20 20 Docetaxel Docetaxel 0 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 0 3 6 9 12 15 18 21 24 27 30 33 36 39 Mos Mos Pts at Risk, n Nivolumab Docetaxel Pts at Risk, n Nivolumab Docetaxel 292 290 233 243 194 194 171 150 148 111 128 89 112 66 97 53 81 45 46 25 18 6 6 3 0 1 0 0 135 137 113 104 86 69 69 46 57 33 51 22 38 17 34 14 29 11 19 9 14 6 7 4 1 1 0 0 Borghaei H, et al. ASCO 2016. Abstract 9025. Slide credit: clinicaloptions.com

  20. CheckMate 017: OS by PD-L1 Expression in Squamous NSCLC 1% PD-L1 Expression Level 5% PD-L1 Expression Level 10% PD-L1 Expression Level 100 100 100 80 80 80 60 60 60 OS (%) 40 40 40 20 20 20 0 0 0 0 3 6 9 15 18 21 24 12 0 3 6 9 15 18 21 24 12 0 3 6 9 15 18 21 24 12 Mos Mos Mos Nivolumab PD-L1+ Nivolumab PD-L1- Docetaxel PD-L1+ Docetaxel PD-L1- Brahmer J, et al. N Engl J Med. 2015;373:123-135. Slide credit: clinicaloptions.com

  21. CheckMate 057: 2-Yr OS Rates* by PD-L1 Expression Level in Nonsquamous NSCLC • PD-L1 expression level associated with magnitude of 2-yr OS benefit starting at lowest level examined (1%) 100 Nivolumab Docetaxel Overall PD-L1 Expression 80 60 OS (%) 40 44 45 20 37 29 25 16 17 18 14 13 0 n = 191 290 79 108 292 123 86 86 123 95 < 1% All Pts ≥ 10% ≥ 1% ≥ 5% HR† (95% CI) 0.75 (0.63-0.91) 0.91 (0.67-1.22) 0.62 (0.47-0.83) 0.48 (0.34-0.68) 0.43 (0.30-0.62) *Rates are Kaplan-Meier estimates, error bars indicate 95% CI.†Comparison of full Kaplan-Meier survival curves for each tx group. Borghaei H, et al. ASCO 2016. Abstract 9025. Slide credit: clinicaloptions.com

  22. KEYNOTE-010: Pembrolizumab vs Docetaxel in Advanced PD-L1–Positive NSCLC • Multicenter, randomized, open-label phase II/III trial • Primary endpoints: OS, PFS • Secondary endpoints: DoR, ORR, safety Pembrolizumab 2 mg/kg IV Q3W (n = 345) Pts with advanced NSCLC who progressed after platinum-based chemotherapy (and TKI if EGFR+ or ALK+); ≥ 1% PD-L1+ tumor cells; ECOG PS 0/1 (N = 1034) Treatment continued for 24 mos or until PD or unacceptable toxicity Pembrolizumab 10 mg/kg IV Q3W (n = 346) Docetaxel 75 mg/m2 IV Q3W (n = 343) Herbst RS, et al. Lancet. 2016;387:1540-1550. Slide credit: clinicaloptions.com

  23. KEYNOTE-010: OS in Pts With PD-L1 TPS ≥ 1% and TPS ≥ 50% Pts With PD-L1 TPS ≥ 50% Pts With PD-L1 TPS ≥ 1% 100 100 80 80 60 60 OS (%) OS (%) 40 40 20 20 0 0 0 5 10 15 20 25 0 5 10 15 20 25 Mos Mos Herbst RS, et al. Lancet. 2016;387:1540-1550. Slide credit: clinicaloptions.com

  24. KEYNOTE-010: OS in Pts With PD-L1 TPS 1% to 49% 100 80 60 OS (%) 40 20 0 0 5 10 15 20 25 Mos Pts at Risk, n Pembrolizumab 2 mg/kg Pembrolizumab 10 mg/kg Docetaxel 205 195 191 149 140 122 64 64 41 29 31 14 9 5 0 0 0 0 Garon EB, et al. ASCO 2016. Abstract 9024. Slide credit: clinicaloptions.com

  25. OAK: Atezolizumab vs Docetaxel in Progressive Advanced NSCLC • Multicenter, randomized, open-label phase III trial • Primary endpoints (first 850 pts enrolled): OS in ITT population; OS in pts with ≥ 1% PD-L1 expression • Secondary endpoints: ORR, PFS, DoR, safety Stratified by PD-L1 expression, histology, prior chemotherapy regimens Atezolizumab 1200 mg IV Q3W (n = 425) Until loss of clinical benefit Metastatic or locally advanced NSCLC (2L/3L), PD on prior platinum-based treatment (N = 1225) No crossover allowed Docetaxel 75 mg/m2 IV Q3W(n = 425) Until PD Rittmeyer A, et al. Lancet. 2016;389:255-265. Slide credit: clinicaloptions.com

  26. OAK: OS in ITT Population 100 80 60 OS (%) HR: 0.73 (95% CI 0.62-0.87; P = .0003) 40 20 Median: 9.6 mos (95% CI: 8.6-11.2) Median: 13.8 mos (95% CI: 11.8-15.7) 0 0 3 6 9 12 15 18 21 24 27 Mos Rittmeyer A, et al. Lancet. 2017;389:255-265. Slide credit: clinicaloptions.com

  27. OAK: OS by PD-L1 Expression Median OS, Mos On-Study Prevalence Subgroup TC3 or IC3 TC2/3 or IC2/3 TC1/2/3 or IC1/2/3* TC0 and IC0 Atezolizumab 20.5 16.3 15.7 12.6 13.8 Docetaxel 8.9 10.8 10.3 8.9 9.6 0.41 16% 0.67 31% 0.74 55% 0.75 45% 0% 20% 40% 60% 80% 100% 0.73 ITT* 100% 0.2 1 2 HR* In favor of atezolizumab In favor of docetaxel *Stratified HR for ITT and TC1/2/3 or IC1/2/3 subgroup. Unstratified HR for other subgroups. Rittmeyer A, et al. Lancet. 2017;389:255-265. Slide credit: clinicaloptions.com

  28. Online Interactive Treatment Decision Support Tool for Advanced NSCLC • 5 lung cancer experts: Drs. Gandara, Edelman, Ramalingam, Wakelee, and West • Enter specific pt and disease characteristics using drop-down menus Available at: clinicaloptions.com/LungTool

  29. Management of ICI Treatment-Related Adverse Events

  30. Immune-Related AEs With Immunotherapy • Endocrine • Hypo- or hyperthyroidism • Adrenal insufficiency • Hypophysitis • Eye • Uveitis • Iritis • Skin • Dermatitis exfoliative • Vitiligo • Alopecia • Pulmonary • Pneumonitis (< 5% incidence) • Hepatic • Hepatitis, autoimmune • Cardiac • Myocarditis • Gastrointestinal • Colitis • Neurologic • Neuropathy • Guillain-Barre • Myasthenia gravis–like syndrome • Renal • Nephritis If not vigilant, may result in more serious immune-related AEs Slide credit: clinicaloptions.com

  31. Time to Onset of First Treatment-RelatedSelect AE With Nivolumab (Any Grade) • Majority of treatment-related AEs occurred within first 3 mos of treatment Skin 10 Gastrointestinal 9 Pulmonary 8 Endocrine 7 Renal 6 Pts With First Event in Category (n) Hypersensitivity/infusion reaction 5 Hepatic 4 3 2 1 0 0-3 > 3-6 > 6-12 > 12-24 Mos Pts still on study, nPts still on treatment, nTotal pts with first event, n 13113124 112736 85512 52251 Reckamp K, et al. WCLC 2015. ORAL02.01. Slide credit: clinicaloptions.com

  32. Online Interactive Algorithm Tool for Immune-Related AE Management • Developed by Jeffrey S. Weber, MD, PhD • Enter specific organ system affected and severity using drop-down menus Available at: clinicaloptions.com/irAETool

  33. Immune-Mediated Pneumonitis • Fairly uncommon, but potentially serious • Pts at increased risk for pneumonitis • NSCLC in the setting of chronic lung inflammation • Prior radiation to lung • History of COPD • Signs and symptoms • Shortness of breath • Dry cough • Decreasing O2 saturation on room air • New/increasing oxygen requirements • Asymptomatic may be detected just on imaging Slide credit: clinicaloptions.com

  34. Immune-Mediated Dermatitis • Reported in up to 40% of pts with anti–CTLA-4 and anti–PD-1 agents • Occasionally severe rashes • Onset variable within a few wks of starting to several wks/mos into therapy • Rule out other etiologies • Generally not infusion related • Manage mild/moderate dermatitis with supportive care ± withholding drug Hodi FS, et al. N Engl J Med. 2010;363:711-723. Images courtesy L. Horn, Vanderbilt University. Slide credit: clinicaloptions.com

  35. Management of Grade 1 Gastrointestinal Treatment-Related Adverse Event

  36. Case 4: Management of Grade 3 Gastrointestinal Treatment-Related Adverse Event • A few days later, the pt’s wife calls saying that as of that day he is having approximately 7-8 episodes of diarrhea/day and is complaining about some abdominal pain

  37. General Principles of Immune-Related Toxicity Management • Management generally based on severity of symptoms • Grade 1: supportive care ± withhold drug • Grade 2: withhold drug, consider redose if toxicity resolves to grade ≤ 1; low-dose corticosteroids (prednisone 1-2 mg/kg/day or equivalent) • Grade 3/4: discontinue drug; high-dose corticosteroids (prednisone 2-4 mg/kg/day or equivalent) tapered over ≥ 1 mo once toxicity resolves to grade ≤ 1 Atezolizumab adverse reaction management brochure. Nivolumab adverse reaction management guide. Pembrolizumab adverse reaction management guide. Slide credit: clinicaloptions.com

  38. Future Directions

  39. KEYNOTE-021: Pembrolizumab + CT as First-line Therapy for Advanced Nonsquamous NSCLC • Randomized phase II cohort of open-label multicohort trial • Primary endpoint: ORR (RECISTv1.1) • Secondary endpoints included: PFS, DoR, OS, and safety Stratified by PD-L1 TPS (< 1% vs ≥ 1%) Pembrolizumab 200 mg IV + Cb/Pem* Q3W x 4 (n = 60) Pembrolizumab up to 24 mos + Pemetrexed maintenance (optional) Pts with stage IIIB/IV nonsquamous NSCLC and ECOG PS 0/1, no previous systemic therapy, no actionable EGFR/ALK mutations (N = 123) Cb/Pem* Q3W x 4 (n = 63) Pemetrexed maintenance (optional) *Cb AUC 5 mg/mL/min; pem 500 mg/m2. Langer CJ, et al. Lancet Oncol. 2016;17:1497-1508. Slide credit: clinicaloptions.com

  40. KEYNOTE-021: First-line CT ± Pembrolizumab in Advanced NSCLC CT Only (n = 55) CT With Pembrolizumab (n = 56) 100 100 80 80 • ORR: 55% • 98% of pts with decrease in tumor burden • ORR: 29% • 82% of pts with decrease in tumor burden 60 60 40 40 20 20 Best Change From Baseline Tumor Size (%) 0 Best Change From Baseline Tumor Size (%) 0 -20 -20 -40 -40 -60 -60 -80 -80 -100 -100 Langer CJ, et al. Lancet Oncol. 2016;17:1497-1508. Slide credit: clinicaloptions.com

  41. KEYNOTE-021: First-line CT + Pembrolizumab vs CT Only OS PFS 100 100 80 80 60 60 PFS (%) 40 40 OS (%) 20 20 0 0 0 5 10 15 20 0 5 10 15 20 Mos Mos Pts at Risk, n (number censored) Pembro + CT CT Pts at Risk, n (number censored) Pembro + CT CT 60 (0) 63 (0) 43 (5) 32 (10) 20 (20) 13 (21) 1 (36) 1 (29) 0 (37) 3 (30) 60 (0) 63 (0) 53 (3) 57 (1) 33 (18) 31 (20) 5 (42) 6 (43) 0 (47) 0 (49) Langer CJ, et al. Lancet Oncol. 2016;17:1497-1508. Slide credit: clinicaloptions.com

  42. KEYNOTE-021: Treatment-Related Adverse Events With Incidence ≥15% Grade 1/2 3/4 Pembro + CT CT alone 64 58 54 44 40 32 27 27 20 19 19 19 18 18 17 17 17 15 13 11 11 12 10 10 Rash Nausea Fatigue Anemia Diarrhea Vomiting Dysgeusia DecreasedAppetite Constipation DecreasedNeutrophils Increased ALT Increased AST Langer CJ, et al. Lancet Oncol. 2016;17:1497-1508. Slide credit: clinicaloptions.com

  43. Dual Checkpoint Blockade in Advanced NSCLC: Phase I Experience *Duravlumab 10-20 mg/kg Q2W or Q4W + tremelimumab 1 mg/kg Q4Wx 6, then Q12Wx 3. †Nivolumab 3 mg/kg Q2W + ipilimumab 1 mg/kg Q6W. ‡Nivolumab 3 mg/kg q2w + ipilimumab 1 mg/kg Q12W. Hellmann MD, et al. Lancet Oncol. 2017;18:31-41. Antonia S, et al. Lancet Oncol. 2016;17:299-308. Slide credit: clinicaloptions.com

  44. Select Ongoing Randomized Phase III Trials of PD-1/PD-L1 Therapy in Advanced NSCLC *All trials enrolling pts as of February 2017. Slide credit: clinicaloptions.com

  45. Conclusions • PD-1/PD-L1 inhibitors have expanded treatment options for pts with advanced NSCLC with a potential for durable benefit • First-line, high PD-L1 expression (≥ 50%): pembrolizumab • Progressive disease: atezolizumab, nivolumab, or pembrolizumab (≥ 1% PD-L1) • PD-L1 expression in the tumor is associated with an increased likelihood of response but the predictive validity of this biomarker is still debated • Vigilance for immune-related AEs by the entire healthcare team along with rapid intervention is key to optimal management • Phase III clinical trials evaluating new combination strategies including checkpoint blockade plus chemotherapy and dual checkpoint blockade are enrolling pts

  46. Go Online for More CCO Coverage of NSCLC! clinicaloptions.com/oncology Downloadable slidesetson NSCLC CME-certified expert analyses on NSCLC and immunotherapy with expert faculty commentary on all the key studies Interactive Treatment Decision Support Tool for NSCLC— see treatment choices of 5 experts for your patient scenarios

More Related