Explosion of Novel Agents, Liquid Biopsies Leading Advancements in Lung Cancer Field

Gina Columbus @ginacolumbusonc
Published: Saturday, Nov 12, 2016

Mark G. Kris, MD

Mark G. Kris, MD

Lung cancer treatment has undergone a game-changing transformation within the past few years, with a burst of FDA approvals of targeted agents and immunotherapies across a number of indications. In the diagnostic arena, identifying targetable mutations through plasma-based assays versus a traditional biopsy has propelled the landscape even more.

Most recently, in October 2016, the FDA approved the PD-1 inhibitor pembrolizumab (Keytruda) for the frontline treatment of patients with metastatic non¬–small cell lung cancer whose tumors have ≥50% PD-L1 expression and who do not harbor EGFR or ALK aberrations. This was an update from pembrolizumab’s initial approval in the second-line setting in October 2015.

Pembrolizumab is joined by two other FDA-approved checkpoint inhibitors nivolumab (Opdivo) and atezolizumab (Tecentriq).

Numerous targeted agents have also been approved aimed at patients with EGFR and ALK mutations or abnormalities. For patients with EGFR-mutant tumors, afatinib (Gilotrif), erlotinib (Tarceva), and gefitinib (Iressa) are on hand, along with osimertinib (Tagrisso), a drug able to target the resistance mutation T790M. With ALK-positive patients, crizotinib (Xalkori), ceritinib (Zykadia), and alectinib (Alecensa) have been approved as targeted therapies, too.

These are just a handful of the advancements highlighted by Mark G. Kris, MD, a program chair of the 11th Annual New York Lung Cancer Symposium® on November 12.

“One wonderful thing that comes out of the NY Lung Cancer Symposium is seeing the number of practitioners that have a focus on lung cancer in our region—seeing their knowledge, their interests in research, and, most importantly, the passion that people have to do a better job for people with lung cancer,” said Kris. “One message of this meeting is when you see it in action, it’s really a beautiful thing, and it’s really good for our patients.”

In an interview with OncLive, Kris, a medical oncologist at Memorial Sloan Kettering Cancer Center, shares his thoughts on the prominent advancements in the field of lung cancer, how liquid biopsies are shaping treatment decisions, and his predictions for the years ahead.

OncLive: There are many topics being presented at this year’s meeting. What are some of the highlights?

Kris: We are very excited about this meeting; it’s actually very special because it brings together individuals from many different specialties who treat lung cancers in the tristate area, and the meeting strives to assemble a diversity of experience with patients, a diversity of opinions regarding how to best treat patients, and then to share them in a very open and nonthreatening way. It is really unique. We try to share each other’s experience and, at the same time, do it in a context of presenting new developments in the field and things that have happened in the last year that have shaped therapy.

What are these advancements that have shaped therapy?

First, we have an evolution in how the targets [for targeted therapies] are found. There is more comprehensive mutational tissue testing and more available tissue testing. Now, in addition to tissue, you have the ability to detect these relevant mutations in blood—both individual ones like T790M or EGFR in next-generation sequencing (NGS) panels of mutations where you can assay what options are available for individual patients. That is something that is rapidly becoming a standard of care here in the United States.

More information is available, as well, about new drugs, such as osimertinib at time of acquired resistance and also as initial therapy. Crizotinib is here with its use in MET exon 14 skipping mutation, and with cabozantinib (Cabomeytx) and its use in RET—all these topics are being discussed. Now, the great opportunity that we have with these multiple agents is how do we select which one to give first, and how do we decide which one to give second? What information is there to make these choices?

What sequencing challenges are we facing now?

The marketplace and individual institution initiatives in the area of testing are just going to move this field so quickly. The problem is which option to choose and not having availability. Many of the insurance carriers have said that when a result is needed, they are agnostic as to the way it is obtained, as long as it is done in a clean setting. A lot of the barriers are gone. The cost barriers are virtually gone. It’s going to get cheaper and cheaper, and more and more available.


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