We have organised Immuno-Oncology Hong Kong 2016; this is actually our first attempt to organise an immune-oncology conference in the Asia-Pacific area. Actually, I am very delighted to have tremendous support from various organisations including the pharmaceutical industry and also from the academic institutes. With good friends from different parts of the world, we have excellent speakers on the area of lung cancer and the management of urothelial bladder cancer as well as on GI cancer and even on sarcoma. With all these experts, they share actually not just on the clinical data but on the basic scientific rationale of how to utilise the immunotherapy in a clinical situation.
There are a few very exceptional talks including the keynote lecture by professor Roy Herbst from Yale and he gave a very comprehensive overview of how PD-L1 can be applicable to management of cancer. Then we have the management of toxicity of the anti-PDL1 therapy by Julie Brahmer from the Johns Hopkins University as well as James Bellaire and James Welsh from the MD Anderson that he had actually provided the scientific basis as well as the clinical application of radiotherapy and immunotherapy. So, all of those are just some examples of the fine lectures provided by the speakers from different parts of the world as well as a great audience. Then we have a very good interactive time; there’s some great questions being raised and so hopefully this is just the beginning of a very good venture in terms of immuno-oncology conferences in Asia.
What was the take-home message from your talk?
In lung cancer we have gone through two major evolutions in the past fifteen years, first the molecular targed therapy that we had a lot of great interest of the EGFR TKI and ALK inhibitor which is now already incorporated as part of the standard treatment for lung cancer. But now with the arrival of immunotherapy first we know that there is second line efficacy with approved two drugs, namely nivolumab and pembrolizumab. The next wave question is how do we combine them? Doctor Daniel Tang this morning gave a discussion on how to combine the EGFR TKI together with the so-called immunotherapy which provides a great concept and then some more data to come. Then for me I actually addressed on two issues: one is how to combine that with chemotherapy and the second how we may combine two different types of immunotherapy together. So I stressed on three factors: number one the biology - we must have learned the basic biological theory and also have some preclinical models to demonstrate the biology. Second, we have to learn the so-called basic single arm data and using the combination as well as address on the issue whether we can use a biomarker when you use two agents. Thirdly, we have to address on the toxicity, whether we are talking about additional toxicity or synergistic toxicity.
All those things have to be looked into before we engage in the so-called phase III study to demonstrate superior effect. I have used a few examples such as the combination of pembrolizumab with chemotherapy. The initial data from the KEYNOTE-021 is highly encouraging with the response rate being 45% compared to chemotherapy which is higher than the chemotherapy alone at 28%. On the other hand is that can we still use the biomarker because in their report they have twenty patients with over 50% expression the response is about 80%. How do we carry on with this data while we know that single agent effect of pembrolizumab is about 40-50% in the over 50% population? So, I think there are still a lot of unanswered questions but then we are in a very good beginning of engaging ourselves into combination therapy using the IO.
