Building on Momentum Is Vital in Lung Cancer

Brittany Lovely
Published: Saturday, Feb 08, 2020

Suresh S. Ramalingam, MD, FASCO, the Roberto C. Goizueta Chair for Cancer Research, professor, Department of Hematology and Medical Oncology, and deputy director of the Winship Cancer Institute of Emory University

Suresh S. Ramalingam, MD, FASCO

Advancements in the prevention and treatment of patients with lung cancer have picked up momentum over the past decade and now is the time to build on that progress according to Suresh S. Ramalingam, MD, FASCO. In a presentation at the 2020 Winter Lung Cancer Conference® Ramalingam reviewed major advancements in lung cancer and identified key areas of focus for the field.1

“There are a lot of challenges, but I think it is fair to say that we have made substantial progress in lung cancer—patients are living longer and better and it is up to us to build on this momentum,” Ramalingam said. He is the Roberto C. Goizueta Chair for Cancer Research, professor, Department of Hematology and Medical Oncology, and deputy director of the Winship Cancer Institute of Emory University.

Building on the advancements in molecular classification, continued exploration of the utility of plasma circulating tumor DNA (ctDNA) and making preventative CT screening accessible for high-risk individuals are 3 important areas for research and education.

Personalizing Medicine In Lung Cancer Holds Strong

Since the detection of EGFR in 2004, lung cancer has been at the forefront of precision medicine. With agents available in the first-line setting for patients with EGFR, ALK, ROS1, BRAF, and NTRK mutations; in the second-line setting for patients with EGFR and ALK mutations; and in the third-line setting for patients with ALK mutations, Ramalingam noted that these therapies have “made survival possible for years as opposed to months when lung cancer was just consistently treated with chemotherapy.”

Looking at EGFR specifically, Ramalingam noted that there have been significant advances in the past 15 years. Five agents are approved to target the mutation, with osimertinib (Tagrisso) approved in both the first- and second-line settings. Recent osimertinib data demonstrated its continued utility 5 years after its approval.

The FLAURA study (NCT02296125) examined osimertinib in the frontline setting compared with the standard EGFR TKIs gefitinib (Iressa) and erlotinib (Tarceva). Osimertinib demonstrated a median overall survival (OS) of 38.6 months (95% CI, 34.5-41.8) compared with 31.8 months (95% CI, 26.6-36.0) with erlotinib or gefitinib (HR, 0.799; 95% CI, 0.641-0.997; P = .0462). The 12-, 14-, and 36-month OS rates were 89%, 74%, and 54% for osimertinib (n = 279) and 83%, 59%, and 44% for the comparator EGFR TKI arm (n = 277), respectively.2

At 3 years, 28% of patients in the osimertinib group and 9% in the comparator group continued on treatment and the median exposure was 20.7 months and 11.5 months, respectively.2

“There is a lot of exciting progress happening in the space and this has been made possible by technologies that allow us to sequence patient’s tumors and help identify the best treatment option for a given patient,” Ramalingam said.

However, molecular testing is not done as often as it should be, according to Ramalingam. Data from a global survey conducted by the International Association for the Study of Lung Cancer demonstrated that 50% to 60% of respondents (N = 2537) said that they are performing molecular testing in their clinic, however 61% reported that most patients in their country do not receive molecular testing. The primary barriers for molecular testing are time, awareness, access, quality, and cost.3

Guided Therapy Using ctDNA Is the Future

The role of ctDNA in lung cancer is in molecular testing to understand mechanisms of resistance to targeted therapy, yet there are data to suggest that ctDNA appears to have a prognostic ability to identify acquired resistance following treatment with an EGFR TKI.

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