Ipatasertib in combination with abiraterone and prednisone for metastatic castrate resistant prostate cancer – first line

Anaplastic large cell lymphoma (ALCL) and inflammatory myofibroblastic tumour (IMT) are both rare conditions that usually affect children and young adults. ALCL is a type of cancer that occurs when T-cells, which contribute to the body’s immune system, become abnormal. IMTs are most commonly non-cancerous (benign), however in some cases the tumour can become cancerous (malignant). Both conditions can be ALK-positive (ALK+), this means that the tumour cells have a mutation in anaplastic lymphoma kinase (ALK) resulting in uncontrolled cell replication. These conditions may not be able to be treated through surgical removal of the tumour (unresectable); they may also come back after treatment (relapse) or be resistant to current treatment options (refractory).

Pembrolizumab is an immunotherapy, meaning it stimulates the body’s immune system by triggering T-cells (a type of white blood cells) to find and kill cancer cells. Lenvatinib is a targeted therapy drug that inhibits cancer growth by preventing the formation of new blood vessels. These drugs modulate different aspects of tumour biology, combining them, may result in improved efficacy and help overcome resistance to immunotherapy. Pembrolizumab in combination with lenvatinib (pembrolizumab administered intravenously and lenvatinib administered orally) would offer an additional first-line treatment option for previously untreated and unresectable advanced melanoma.

Cemiplimab in combination with chemotherapy is in clinical development for the treatment of advanced or metastatic non-small cell lung cancer (NSCLC). NSCLC makes up the majority of lung cancers in the UK and at the metastatic stage (stage IV), the disease has already spread from the lungs to other sites. Symptoms of lung cancer include a persistent cough, shortness of breath, coughing up blood, aches and pains in the chest or shoulder, loss of appetite, weight loss and fatigue. Most patients with NSCLC are diagnosed at the advanced/metastatic stage where curative treatment with surgery is unsuitable. Advanced NSCLC is not usually curable; there is therefore the need for additional treatment options.

Oral cabozantinib is a tyrosine kinase inhibitor (TKI) that works by blocking the activity of enzymes known as tyrosine kinases which can be found in certain receptors in cancer cells. Intravenous atezolizumab is a monoclonal antibody, a type of protein designed to recognise and attach to a protein called PD-L1, which is present on many cancer cells. Their combination has shown promising antitumour activity and tolerability in patients with solid tumours including HCC. If licensed, cabozantinib in combination with atezolizumab will provide an additional first-line treatment option for patients with advanced HCC.