Dr. Socinski on Current State of Treatment in NSCLC

Mark A. Socinski, MD
Published: Thursday, Feb 21, 2019



Mark A. Socinski, MD, executive medical director, AdventHealth Medical Group, discusses the current state of treatment for patients with non–small cell lung cancer (NSCLC).

In 2018, the outlook for patients with NSCLC is much better assuming that community oncologists utilize what Socinski considers to be the multi-faceted standard of care. In terms of stage IV disease, you need to first define the molecular nature of the cancer. If the patient has a tumor that is driven by an alteration like EGFR or ALK, there is a growing list of oral targeted therapies. The other important aspect is the integration of immunotherapy in accordance with PD-L1 testing to identify which patients have a higher likelihood of benefitting from this approach.

Given the expansion of the knowledge researchers have regarding the basic biology of the disease, they now know they should be testing for mutations like EGFR, ROS1, and BRAF at the very least, but also for RET translocations, MET alterations, and HER2 [mutations]. Testing patients for these mutations can match them with therapies that are more effective to their disease than standard chemotherapy.

In addition, arguably the biggest advancement in NSCLC has been bringing immunotherapy, which had previously been utilized in the second line, to the frontline standard of care across squamous and nonsquamous histologies. The outlook and prognosis for patients has rapidly improved over the last few years, based on molecular observations as well as the benefit of immunotherapy.
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Mark A. Socinski, MD, executive medical director, AdventHealth Medical Group, discusses the current state of treatment for patients with non–small cell lung cancer (NSCLC).

In 2018, the outlook for patients with NSCLC is much better assuming that community oncologists utilize what Socinski considers to be the multi-faceted standard of care. In terms of stage IV disease, you need to first define the molecular nature of the cancer. If the patient has a tumor that is driven by an alteration like EGFR or ALK, there is a growing list of oral targeted therapies. The other important aspect is the integration of immunotherapy in accordance with PD-L1 testing to identify which patients have a higher likelihood of benefitting from this approach.

Given the expansion of the knowledge researchers have regarding the basic biology of the disease, they now know they should be testing for mutations like EGFR, ROS1, and BRAF at the very least, but also for RET translocations, MET alterations, and HER2 [mutations]. Testing patients for these mutations can match them with therapies that are more effective to their disease than standard chemotherapy.

In addition, arguably the biggest advancement in NSCLC has been bringing immunotherapy, which had previously been utilized in the second line, to the frontline standard of care across squamous and nonsquamous histologies. The outlook and prognosis for patients has rapidly improved over the last few years, based on molecular observations as well as the benefit of immunotherapy.

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