Nice write-up. I have no doubt more publications will come out looking at the immunological sub-studies they surely did at MDACC using these patients.
Many oncologists were clamoring for adjuvant osi to become SOC after ADAURA showed a big PFS benefit (but hadn’t reported OS). These results are so impressive, I feel myself falling into the camp that we should start using I-SABR now. If not, I hope PACIFIC-4 is viewed as confirmatory, and 4 months of immunotx becomes standard. Let pharma prove that the additional 20 months of immunotherapy is beneficial compared to the 4 months given in this MDACC trial.
As you note, the 4 cycles (so much shorter duration) is a key component to this study. And I agree with you, I-SABR seems like the path - if anything, author conclusions are too measured from my perspective.
Great write up as usual. I enjoy your content and learn a lot.
I will say I think the correct comparison is not going to be I-SABR vs Surgery, but rather I-SABR vs I-Surgery.
To me this study isn't evidence of a synergistic effect as it's possible immunotherapy has an independent effect for early stage lung.
Just as chemo-immunotherapy is making headway in neoadjuvant treatment for surgery in stage III lung I expect there will be efforts by the surgeons to combine Immunotherapy with resection in this cohort as well.
Excellent point. Could just be immunotherapy affect - and important that it was short. But now this appears real and onus seems to shift to the surgery approach to demonstrate comparable improvements. But there is at least a real chance that the immunomodulatory affects are real from SABR. Time will tell. Thanks for reading along.
Nice write-up. I have no doubt more publications will come out looking at the immunological sub-studies they surely did at MDACC using these patients.
Many oncologists were clamoring for adjuvant osi to become SOC after ADAURA showed a big PFS benefit (but hadn’t reported OS). These results are so impressive, I feel myself falling into the camp that we should start using I-SABR now. If not, I hope PACIFIC-4 is viewed as confirmatory, and 4 months of immunotx becomes standard. Let pharma prove that the additional 20 months of immunotherapy is beneficial compared to the 4 months given in this MDACC trial.
As you note, the 4 cycles (so much shorter duration) is a key component to this study. And I agree with you, I-SABR seems like the path - if anything, author conclusions are too measured from my perspective.
Great write up as usual. I enjoy your content and learn a lot.
I will say I think the correct comparison is not going to be I-SABR vs Surgery, but rather I-SABR vs I-Surgery.
To me this study isn't evidence of a synergistic effect as it's possible immunotherapy has an independent effect for early stage lung.
Just as chemo-immunotherapy is making headway in neoadjuvant treatment for surgery in stage III lung I expect there will be efforts by the surgeons to combine Immunotherapy with resection in this cohort as well.
Excellent point. Could just be immunotherapy affect - and important that it was short. But now this appears real and onus seems to shift to the surgery approach to demonstrate comparable improvements. But there is at least a real chance that the immunomodulatory affects are real from SABR. Time will tell. Thanks for reading along.