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Locally Advanced Disease

• START Trial: MUC1 is often over expressed in lung cancer. In preclinical studies, a vaccine produced an increase in T-cells or an immunotherapy response. The START trial is a large phase III study for patients with stage III lung cancer with either stable disease or an objective response to chemo and radiation therapy. These patients received the MUC 1 vaccine for eight weeks. Although, overall, the trial did not extend overall survival, the group of patients who received their chemo and radiation at the same time did have a 10 month advantage in overall survival. The reasons for this are not entirely clear, but may result from a combination of factors.

Advanced Disease

• PROSE Trial: VeriStrat testing is a new way of profiling lung cancers based on a number of prognostic factors. The PROSE trial studied whether VeriStrat has any predictive value in determining the success of chemotherapy and targeted therapy. The results did not show any difference between the two arms for the VeriStrat Good patients, but the VeriStrat Poor patients receiving chemotherapy did better than those receiving the targeted therapy.
• Ganestespib is a novel agent that inhibits the Hsp-90 pathway which is over expressed in cancer cells. The GALAXY trial compared ganestespib alone with ganestespib and daclataxel. In patients with advanced lung cancer, earlier trials have shown that patients who did well on previous therapies are more likely to do better with this agent.
• Anti-PD-1. This trial uses nivolumab with advanced lung cancer patients who have been heavily pretreated. Response rates for both squamous and non-squamous cell patients have been in the 20 to 25% range. This is promising, and can be easily administered in an outpatient setting.