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Final Thoughts on NSCLC

Panelists:Benjamin P. Levy, MD, Mount Sinai Health Systems;Chandra P. Belani, MD, Penn State Cancer Institute;Marina Garassino, MD, National Cancer Institute Milan, Italy;Sarah B. Goldberg, MD, MPH, Yale Cancer Center;Ramaswamy Govindan, MD, Washington University School of Medicine;Mark G. Kris, MD, Memorial Sloan-Kettering Cancer Center
Published Online: Monday, Oct 17, 2016



Transcript:

Benjamin P. Levy, MD:
This has been extremely informative. Before we end this discussion, I’d like to get final thoughts from each of our panelists: Dr. Belani, Dr. Garassino, Dr. Goldberg, Dr. Govindan, and Dr. Kris. So, Dr. Belani, any final thoughts, any messages, any take-homes as we wrap up this panelist discussion?

Chandra P. Belani, MD: So, I think that at this point in time, we have, as Mark would say, multiple lung cancers rather than one lung cancer. We have broken it down just now to treat these patients in various settings, at various levels, and at various lines of treatment. I think the best way that we can move forward is to, again, take advantage of the biology of the tumor. But, we also need to see how we can sequence these treatments in the future. I still see that there will be a benefit of doing these sequential studies with chemotherapy in single agents rather than combining it empirically, so as to get a better feel for where we are headed and how to optimally use these agents, whether it was targeted agents, the immunotherapeutic agents, or chemotherapy.

Benjamin P. Levy, MD: Dr. Garassino, final thoughts.

Marina Garassino, MD: I started as a physician when there was only chemotherapy. Now we have many, many drugs. So, I think that we have, again, to come back to biology, but also work together at the global level as academia to define the patients who are really benefitting of all the drugs and to define the best sequences, the best doses, and the best schedules for everything.

Benjamin P. Levy, MD: Dr. Govindan, your final thoughts.

Ramaswamy Govindan, MD: I think it’s important that we pay attention to biology, and we should do everything we can to get our patients on appropriate clinical trials, follow the data very carefully, and then try to move along with science.

Benjamin P. Levy, MD: Dr. Goldberg.

Sarah B. Goldberg, MD, MPH: I think it’s such an interesting and exciting time. There are so many different advances. We’ve talked about so many of them here. There are targeted therapy advances, immune therapy advances, and single agents versus combinations. There are so many different moving parts, it’s hard to know what will be next. Similar to what Govindan just said, I think putting patients on trials is really what I’m still trying to do. Even though we have great FDA-approved drugs that are clearly better than what we had a few years ago, I’m still trying to put patients on trials, because they’re not good enough. They’re not working for everyone. They’re actually working for the minority of patients. So, trying to find which patients benefit from the single agent versus the combination, it really is something that we still need to think about in trials as opposed to just using these new, exciting drugs. I think still trying to answer the questions is so important.

Benjamin P. Levy, MD: Dr. Kris.

Mark G. Kris, MD: I just echo something that you said, Ben: our job has gotten better, because we have so many things to offer. It’s also gotten much harder. As people live longer, we have to make more decisions, and, at every single decision point now, we have to think about choices we never thought about. Who would ever think that we’d be taking out liver metastases in people who have metastatic disease? Who would think that’s okay a few years ago? It’s something we do now and we believe that it helps folks. The one thing I still want us to do, ‘to keep our eye on the prize’ as my final words is, we really got to look to curative strategies. It’s nice to bend the curve, but you want to raise the curve. And, I urge everybody to think about, in every individual patient, is there a strategy that can lead to cure? That’s really what you want to do, and that’s what the patient wants.

Benjamin P. Levy, MD: So, thanks to all of you for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this peer-exchange discussion to be useful and informative.

Transcript Edited for Clarity

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Transcript:

Benjamin P. Levy, MD:
This has been extremely informative. Before we end this discussion, I’d like to get final thoughts from each of our panelists: Dr. Belani, Dr. Garassino, Dr. Goldberg, Dr. Govindan, and Dr. Kris. So, Dr. Belani, any final thoughts, any messages, any take-homes as we wrap up this panelist discussion?

Chandra P. Belani, MD: So, I think that at this point in time, we have, as Mark would say, multiple lung cancers rather than one lung cancer. We have broken it down just now to treat these patients in various settings, at various levels, and at various lines of treatment. I think the best way that we can move forward is to, again, take advantage of the biology of the tumor. But, we also need to see how we can sequence these treatments in the future. I still see that there will be a benefit of doing these sequential studies with chemotherapy in single agents rather than combining it empirically, so as to get a better feel for where we are headed and how to optimally use these agents, whether it was targeted agents, the immunotherapeutic agents, or chemotherapy.

Benjamin P. Levy, MD: Dr. Garassino, final thoughts.

Marina Garassino, MD: I started as a physician when there was only chemotherapy. Now we have many, many drugs. So, I think that we have, again, to come back to biology, but also work together at the global level as academia to define the patients who are really benefitting of all the drugs and to define the best sequences, the best doses, and the best schedules for everything.

Benjamin P. Levy, MD: Dr. Govindan, your final thoughts.

Ramaswamy Govindan, MD: I think it’s important that we pay attention to biology, and we should do everything we can to get our patients on appropriate clinical trials, follow the data very carefully, and then try to move along with science.

Benjamin P. Levy, MD: Dr. Goldberg.

Sarah B. Goldberg, MD, MPH: I think it’s such an interesting and exciting time. There are so many different advances. We’ve talked about so many of them here. There are targeted therapy advances, immune therapy advances, and single agents versus combinations. There are so many different moving parts, it’s hard to know what will be next. Similar to what Govindan just said, I think putting patients on trials is really what I’m still trying to do. Even though we have great FDA-approved drugs that are clearly better than what we had a few years ago, I’m still trying to put patients on trials, because they’re not good enough. They’re not working for everyone. They’re actually working for the minority of patients. So, trying to find which patients benefit from the single agent versus the combination, it really is something that we still need to think about in trials as opposed to just using these new, exciting drugs. I think still trying to answer the questions is so important.

Benjamin P. Levy, MD: Dr. Kris.

Mark G. Kris, MD: I just echo something that you said, Ben: our job has gotten better, because we have so many things to offer. It’s also gotten much harder. As people live longer, we have to make more decisions, and, at every single decision point now, we have to think about choices we never thought about. Who would ever think that we’d be taking out liver metastases in people who have metastatic disease? Who would think that’s okay a few years ago? It’s something we do now and we believe that it helps folks. The one thing I still want us to do, ‘to keep our eye on the prize’ as my final words is, we really got to look to curative strategies. It’s nice to bend the curve, but you want to raise the curve. And, I urge everybody to think about, in every individual patient, is there a strategy that can lead to cure? That’s really what you want to do, and that’s what the patient wants.

Benjamin P. Levy, MD: So, thanks to all of you for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this peer-exchange discussion to be useful and informative.

Transcript Edited for Clarity
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