Ticiana A. Leal, MD, is an associate professor and director of the Thoracic Medical Oncology Program in the Department of Hematology and Medical Oncology at Emory University School of Medicine in Atlanta, Georgia; as well as medical director of the Clinical Trials Office and leader of the Lung Cancer Disease Team at the Winship Cancer Institute of Emory University
Dr. Ticiana Leal introduces the discussion on treatment selection and sequencing in EGFR-mutated advanced non-small cell lung cancer (NSCLC), emphasizing that biomarker testing results must be available before initiating any frontline treatment discussion. With osimertinib monotherapy, osimertinib plus chemotherapy, and amivantamab plus lazertinib all now guideline-recommended, she reviews the comparative efficacy data driving patient discussions.
Dr. Sands discusses tarlatamab's unique mechanism as a bispecific T-cell engager linking DLL3 on tumor cells to CD3 on T cells, creating an antigen-directed immune response distinct from other therapeutic approaches. He characterizes the second-line DeLLphi-304 trial as establishing an entirely new paradigm, representing the only example of one drug outperforming others in SCLC's second-line setting across PFS, OS, tolerability, and symptom improvement.
Dr. Leal discusses practical logistics of lurbinectedin plus atezolizumab, administered together every 21 days. She incorporates maintenance discussions into initial treatment planning, particularly important for patients traveling long distances with caregivers. Most patients with ports prefer intravenous administration despite subcutaneous atezolizumab being an option with comparable efficacy, safety, and drug levels but shorter infusion time.
Dr. Shields confirms that NCCN guidelines now recommend lurbinectedin plus atezolizumab as preferred maintenance therapy following 4 cycles of chemotherapy and immunotherapy, with the specific footnote limiting this to patients with ECOG performance status 0 to 1 and no history of brain metastases. She strictly follows the brain metastasis exclusion criteria for treatment-naive patients but notes this restriction wasn't applied in second or third-line relapse settings.
Dr. Joshua Sabari introduces the program on evolving maintenance and sequencing strategies in extensive-stage small cell lung cancer (ES-SCLC), joined by Dr. Anne Chiang from Yale, Dr. Jacob Sands from Dana-Farber, Dr. Misty Shields from Indiana University, and Dr. Ticiana Leal from Emory University's Winship Cancer Institute.
Dr. Wistuba emphasizes the critical need for reinforcing RNA testing alongside DNA testing for comprehensive NGS in lung cancer.
Dr. Leal outlines her approach to frontline treatment selection for newly diagnosed patients with ROS1-positive lung cancer.
Dr. Rodriguez outlines patient education strategies emphasizing partnership from treatment initiation, as clinical trials demonstrate over half of patients require dose adjustments.
Dr. Rodriguez reviews historical toxicity profiles from earlier ROS1 inhibitors, noting that crizotinib and entrectinib presented novel side effects including visual field changes preventing night driving due to floaters, along with liver function test (LFT) abnormalities requiring monitoring.
Dr. Wistuba explains that acquired resistance to ROS1-targeted therapies frequently involves on-target mutations, with G2032R representing the most frequently observed resistance mutation among 10 to 12 described mutations that affect the ATP binding site and reduce drug binding efficiency.
Martin F. Dietrich, MD, PhD, and Ticiana Leal, MD, discuss other potential treatment avenues to explore in HER2-mutant non–small cell lung cancer.
Martin F. Dietrich, MD, PhD, and Ticiana Leal, MD, discuss how the NCCN Guidelines can help supplement HER2-mutant non–small cell lung cancer management decisions.
Ticiana Leal, MD, discusses frontline zongertinib in HER2-mutant non-small cell lung cancer, including activity in patients with active brain metastases, based on data from the BeamionLUNG-1 study presented at ELCC 2026.
Dr. Wistuba addresses the complexity of NGS reports that may include multiple abnormalities beyond ROS1 fusions.
Dr. Wistuba confirms that fusion variant identification does not impact treatment selection, emphasizing that ROS1-positive versus ROS1-negative status represents the key clinical decision point.
Martin F. Dietrich, MD, PhD, and Ticiana Leal, MD, examine sequencing considerations between tyrosine kinase inhibitors and antibody-drug conjugates in HER2-mutant non–small cell lung cancer.
Martin F. Dietrich, MD, PhD, and Ticiana Leal, MD, discuss toxicity management with TKIs in HER2-mutant non–small cell lung cancer.
Ticiana Leal, MD, discusses screening for LEMS in patients with SCLC.
Dr. Wistuba provides detailed information about ROS1 gene fusions, discovered in the 1980s with over 30 to 40 fusion partners identified that constitutively activate ROS1 in cells, leading to malignant properties.
Dr. Leal emphasizes that although actionable genomic alterations like ROS1 are rare, their clinical implications are enormous. Following National Comprehensive Cancer Network (NCCN) guidelines, these targets should be acted upon in the first-line setting as the initial targeted therapy treatment.
Dr Leal discusses variability in community practice and evolving treatment strategies for patients with small cell lung cancer.
Martin F. Dietrich, MD, PhD, and Ticiana Leal, MD, discuss factors that inform sevabertinib and zongertinib treatment selection in HER2-mutant NSCLC.
Martin F. Dietrich, MD, PhD, and Ticiana Leal, MD, discuss frontline therapy approaches in HER2-mutant non–small cell lung cancer and the evolving role of chemoimmunotherapy.
Martin F. Dietrich, MD, PhD, and Ticiana Leal, MD, discuss the importance of biomarker testing in non–small cell lung cancer and tools for detecting HER2-mutant disease.
Panelists discuss the role of ctDNA (liquid biopsy) in clinical practice, highlighting its benefits and limitations in detecting actionable mutations, interpreting results, and guiding treatment decisions when tissue testing is insufficient.
Panelists discuss strategies for identifying and managing ROS1-positive NSCLC, focusing on comprehensive testing approaches, emerging clinical data, and factors that guide treatment decisions.
Experts explore biomarkers, sequencing, and access strategies for extensive-stage small cell lung cancer maintenance, spotlighting tarlatamab, ADC combos, and clinical trials.
Relapsed small cell lung cancer care evolves as tarlatamab boosts survival but needs CRS/ICANS monitoring, while lurbinectedin offers simpler dosing.
Experts weigh maintenance options after chemo-immunotherapy in extensive-stage SCLC, navigating brain mets, cytopenias, and real-world care barriers.
Experts weigh brain metastases limits in IMFORTA and share real-world tips for maintenance lurbinectedin plus atezolizumab.
November 9th 2023
October 19th 2023
