Jordi Remon1, Kathryn Yan2
1Paris-Saclay University, Institut Gustave Roussy, Villejuif, France; 2TLCR Editorial Office, AME Publishing Company
Correspondence to: Kathryn Yan. TLCR Editorial Office, AME Publishing Company. Email: editor@tlcr.org.
Editor’s note
Translational Lung Cancer Research (TLCR) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year TLCR launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.
The special series “Immunotherapy in Other Thoracic Malignancies and Uncommon Populations” (1) edited by Dr. Jordi Remon (Figure 1) and Dr. Benjamin Besse has attracted many readers since its publication. In this special series, a group of renowned international specialists involved in the management of thoracic malignancies present a comprehensive and timely review of state-of-the-art of ICI in thoracic malignancies, discussing the lights and shadows of ICIs, either in under-represented patients with non-small cell lung cancer (NSCLC) in clinical trials, as well as the efficacy of ICIs in thoracic malignancies other than NSCLC. At this moment, we are honored to have an interview with Dr. Remon to share his scientific career experience and insights on this special series.
Figure 1 Dr. Jordi Remon
Expert introduction
Dr. Jordi Remon, MD, PhD is medical oncologist currently working as consultant in the Thoracic Oncology Department at Gustave Roussy (France). Dr. Remon deals with patients with lung cancer, as well as mesothelioma and thymic malignancies. His research interests focus on the application of personalized therapeutic strategies based on molecular abnormalities, circulating biomarkers and early drug development in thymic malignancies and thoracic tumors. Dr. Remon has authored and co-authored several peer-reviewed articles; and Dr Remon has served as (co)-Principal Investigator for several phase II/III clinical trials. Dr Remon is member from ESMO, EORTC (secretary of Lung Cancer Group since January 2021), IASLC, and SLCG.
Interview
TLCR: What motivated you to specialize in the field of thoracic malignancies?
Dr. Remon: At the time I started my residency lung cancer was already an orphan disease with some lights at the end of the tunnel showing that personalized treatment approach could be feasible. Indeed, patients with thoracic malignancies due to smoking pattern may have several comorbidities meaning that a part of medical oncology you can be doctor. Based on the potential scientific revolution, the capacity to perform medicine in a global point of view and that you can have a close relationship with patients, I decided to specialize in thoracic malignancies.
TLCR: As you are experienced in this field, do you have any cases that are particularly impressive to you? Could you share one or two with us?
Dr. Remon: I’m always surprised how strong are some patients. I admire, their capacity to confront bad news and the incertitude of the future in some cases. I worked at Gustave Roussy 2015 and 2016, and now in 2023 when I came back, I have met with patients from my “old-time”, including patients with leptomeningeal carcinomatosis diagnosed in 2016 that thanks to personalized approach are alive. This is for me really amazing. I think that the future challenge is to elucidate the subgroup of patients with higher risk to develop brain metastases and the best treatment approach upfront. Probably, we can’t offer the same treatment to all patients despite sharing the same oncogenic alteration.
TLCR: Compared with chemotherapy alone, what are the advantages and disadvantages of chemotherapy with immune-strategy?
Dr. Remon: Nowadays, the immune checkpoint blockers either as monotherapy or in combination with other immunotherapies or chemotherapies is the standard of care. This strategy improves the outcome compared with chemotherapy alone, and aims to have a long-term survivor not previously achieved with chemotherapy alone. For me the major disadvantages of immunotherapy are more clinical challenges such as: why 2 years of treatment in first-line? could we reduce treatment exposure, therefore reducing the financial toxicity? Do we really need immunotherapy every 3 weeks? Could we de-escalate time schedule? This is really important now that this strategy is standard in the perioperative setting. Finally, how to treat patients with immune-resistant disease is an urgent unmet need in daily practice.
TLCR: How do you view the prospect of ICI in thoracic malignancies treatment, and what breakthroughs do you hope to see in the field of lung cancer treatment?
Dr. Remon: As I mentioned before, probably we have reached a potential plateau in the efficacy of immunotherapy in the first-line setting. Now we must modulate how to prescribe this strategy regarding to: time of treatment administration, schedule of administration (every 3 or 6 weeks not increasing the dose), route of administration (subcutaneous), new combinations (with antibody drug conjugated), applicability of circulating tumor DNA for making treatment decisions and how to treat immune-resistant disease. All these challenges are not only in metastatic setting also in earlier stages of the disease where immunotherapy is already standard of care.
TLCR: Is the topic of this special series associated with any of your recent research projects? Would you please share some significant researches you are working on?
Dr. Remon: Currently I’m participating in a clinical trial lead by Prof. Besse, the PULSE trial. This is a de-escalate clinical trial. In patients with advanced non-squamous NSCLC and with no progression after up to 4 cycles of pembrolizumab with platinum-based chemotherapy patients are randomized to pembrolizumab 200 mg every 6 weeks as maintenance treatment vs standard dose (200 mg every 3 weeks). The primary endpoint of the trial is overall survival. This is an academic clinical trial aiming to answer a relevant clinical question, and these kinds of trials must be performed in academia environment as much as possible.
TLCR: If given an opportunity to update this special series, what would you like to moderate, add or emphasize to provide a more informative series?
Dr. Remon: I think that the most important is to try to define subgroup of patients upfront, learn to apply dynamic markers for making dynamic treatment decisions and explore mechanism of immune-resistance.
Reference
- Immunotherapy in Other Thoracic Malignancies and Uncommon Populations. Available online: https://tlcr.amegroups.com/post/view/immunotherapy-in-other-thoracic-malignancies-and-uncommon-populations