Liza C. Villaruz, MD

Liza C. Villaruz, MD, assistant professor of medicine, Division of Hematology/Oncology, University of Pittsburgh, discusses EGFR-targeted therapies in non—small cell lung cancer (NSCLC).

Villaruz says that osimertinib (Tagrisso) is still the frontline tyrosine kinase inhibitor (TKI) of choice in the treatment of 

-mutant NSCLC, both with regard to systemic disease control and central nervous system (CNS) involvement control. Osimertinib is well tolerated and a has a very good therapeutic index. It will be important for researchers to follow the data with lazertinib, another third-generation TKI that could widen the options in this space, notes Villaruz. In September 2018, the FDA approved dacomitinib (Vizimpro) for the frontline treatment of patients with 

 exon 19 deletion or exon 21 L858R substitution mutations.

Ongoing research is also looking at novel combinations of TKIs with VEGF inhibitors like ramucirumab (Cyramza) and bevacizumab (Avastin). Villaruz concludes that these combinations could be particularly effective for patients with CNS metastases.

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Liza C. Villaruz, MD, assistant professor of medicine, Division of Hematology/Oncology, University of Pittsburgh, discusses EGFR-targeted therapies in non–small cell lung cancer.

Dr. Villaruz on EGFR-Targeted Therapies in NSCLC

Liza C. Villaruz, MD, assistant professor of medicine, Division of Hematology/Oncology, University of Pittsburgh, discusses PD-L1 expression in lung cancer.

The level of PD-L1 expression is the most important factor in the selection of immunotherapy for patients with lung cancer, says Villacruz. For patients who have an overexpression of PD-L1 in their tumors, Villacruz says that she usually prescribes single-agent pembrolizumab (Keytruda). This is due to the significant response rates of about 45%, but that rate of response can be increased with the addition of chemotherapy.

This comparison needs to be taken with a grain of salt, Villacruz says, as the data with pembrolizumab and the data with pembrolizumab plus chemotherapy have not been studied head-to-head. With that being said, Villacruz says that in patients who express less than 50% PD-L1, her standard of care is pembrolizumab plus chemotherapy. For patients who overexpress PD-L1, pembrolizumab monotherapy is still Villacruz’s first choice.

Liza C. Villaruz, MD, assistant professor of medicine, Division of Hematology/Oncology, University of Pittsburgh, discusses PD-L1 expression in lung cancer.
 

Author | Liza C. Villaruz, MD

Articles

Dr. Villaruz on EGFR-Targeted Therapies in NSCLC

Dr. Villaruz Discusses PD-L1 Expression in Lung Cancer