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Pearls of Wisdom for the Field of NSCLC

Panelists: Benjamin P. Levy, MD, Johns Hopkins Sidney Kimmel Cancer Center; Hossein Borghaei, DO, MS, Fox Chase Cancer Center; Roy S. Herbst, MD, PhD, Yale Cancer Center; Suresh S. Ramalingam, MD, Emory University School of Medicine; Naiyer A. Rizvi, MD, Columbia University Medical Center; Thomas E. Stinchcombe, MD, Duke Cancer Institute
Published: Wednesday, Feb 28, 2018



Transcript: 

Benjamin P. Levy, MD: This has been a great discussion. Before we conclude, I’d like to invite each of our panelists to remark with some closing thoughts regarding that which we have just discussed. Hoss, you want to start with some pearls?

Hossein Borghaei, DO, MS: Sure. I think I’ll go back to what I said a little bit earlier. We want to deliver the best care to the right patient, so right treatment for the right patient. I don’t think we can lose sight of that. So, the idea of finding the right biomarker to direct your therapy for the right patient I think is absolutely important. And I think, if anything, our discussion has clearly shown that whether you’re talking about immunotherapy with chemotherapy, without chemotherapy, or with immunotherapy, you need to figure out the patient who is going to benefit the most from it. Going back to our ALK discussion, how we are going to decide who is going to get what goes back to doing the studies to figure out which treatment fits the patient the best. It is not just appropriate. I think this is what we owe to our patients and to the field to work towards having that level of specificity. We deal with a very heterogeneous population, and I think the treatment is going to have to be heterogeneous by definition.

Benjamin P. Levy, MD: OK. Roy?

Roy S. Herbst, MD, PhD: Well, we’ve seen huge advances in lung cancer in the last 20 years with targeted therapy first and now immunotherapy. So, really, we have multiple tools that we use. It used to be just chemotherapy, radiation, and surgery, and we talked a bit about that today in locally advanced disease. But now we have to bring the targeted therapy and immunotherapy, along with supportive care. So, it’s an interesting but an important time for us to personalize this, to use these tools to maximize survival for patients with the best quality of life, and I think we’ve talked about a lot of interesting aspects of this today that are going to go forward.

Benjamin P. Levy, MD: Suresh?

Suresh S. Ramalingam, MD: I want to thank you for the opportunity to be part of this panel. I enjoyed learning from my colleagues. For our participants, I would say that for any patient with newly diagnosed nonsquamous non–small cell lung cancer, we need at least 5 tests done. You need information on EGFR, ALK, ROS-1, BRAF, and PD-L1. These are the 5 markers for which there are defined therapies, so make sure you have that information. For a squamous patient, PD-L1 should be conducted at the time of diagnosis, and, based on this, the treatment algorithms will go afterwards.

Benjamin P. Levy, MD: Naiyer?

Naiyer A. Rizvi, MD: I think you’ve covered it. I think the only conclusion I can make is that whether it’s targeted therapy or immunotherapy, it’s exciting to realize that it’s all genetically driven. The hardest person for a cancer center to find and hire is a computational biologist right now because the genetics of immunotherapy are just exploding. And I think you’re going to see a lot more excitement in that space.

Benjamin P. Levy, MD: Tom?

Thomas E. Stinchcombe, MD: While the panelists have touched on the issues of biomarker and selection, I guess some of my thoughts are there’s a lot of enthusiasm about immunotherapy, but we also have to be very vigilant about the immunotherapy toxicities. Some of these can creep up on you and making sure that you’re aware of them is important. And I think I’d like to see the move towards using them in earlier-stage disease because there’s more promise. I think that’s why our support of some of the trials ongoing is really critical.

Benjamin P. Levy, MD: I’d like to thank all the panelists for an excellent discussion. I’ve learned a tremendous amount from all of us here, and I think each of us has a different angle of coming in and it makes for a nice discussion for a variety of topics. So, thank you. Thank you all for contributions to this discussion. On behalf of our panel, we thank you for joining us and we hope you found this Peer Exchange® discussion to be insightful and informative.

Transcript Edited for Clarity 

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Transcript: 

Benjamin P. Levy, MD: This has been a great discussion. Before we conclude, I’d like to invite each of our panelists to remark with some closing thoughts regarding that which we have just discussed. Hoss, you want to start with some pearls?

Hossein Borghaei, DO, MS: Sure. I think I’ll go back to what I said a little bit earlier. We want to deliver the best care to the right patient, so right treatment for the right patient. I don’t think we can lose sight of that. So, the idea of finding the right biomarker to direct your therapy for the right patient I think is absolutely important. And I think, if anything, our discussion has clearly shown that whether you’re talking about immunotherapy with chemotherapy, without chemotherapy, or with immunotherapy, you need to figure out the patient who is going to benefit the most from it. Going back to our ALK discussion, how we are going to decide who is going to get what goes back to doing the studies to figure out which treatment fits the patient the best. It is not just appropriate. I think this is what we owe to our patients and to the field to work towards having that level of specificity. We deal with a very heterogeneous population, and I think the treatment is going to have to be heterogeneous by definition.

Benjamin P. Levy, MD: OK. Roy?

Roy S. Herbst, MD, PhD: Well, we’ve seen huge advances in lung cancer in the last 20 years with targeted therapy first and now immunotherapy. So, really, we have multiple tools that we use. It used to be just chemotherapy, radiation, and surgery, and we talked a bit about that today in locally advanced disease. But now we have to bring the targeted therapy and immunotherapy, along with supportive care. So, it’s an interesting but an important time for us to personalize this, to use these tools to maximize survival for patients with the best quality of life, and I think we’ve talked about a lot of interesting aspects of this today that are going to go forward.

Benjamin P. Levy, MD: Suresh?

Suresh S. Ramalingam, MD: I want to thank you for the opportunity to be part of this panel. I enjoyed learning from my colleagues. For our participants, I would say that for any patient with newly diagnosed nonsquamous non–small cell lung cancer, we need at least 5 tests done. You need information on EGFR, ALK, ROS-1, BRAF, and PD-L1. These are the 5 markers for which there are defined therapies, so make sure you have that information. For a squamous patient, PD-L1 should be conducted at the time of diagnosis, and, based on this, the treatment algorithms will go afterwards.

Benjamin P. Levy, MD: Naiyer?

Naiyer A. Rizvi, MD: I think you’ve covered it. I think the only conclusion I can make is that whether it’s targeted therapy or immunotherapy, it’s exciting to realize that it’s all genetically driven. The hardest person for a cancer center to find and hire is a computational biologist right now because the genetics of immunotherapy are just exploding. And I think you’re going to see a lot more excitement in that space.

Benjamin P. Levy, MD: Tom?

Thomas E. Stinchcombe, MD: While the panelists have touched on the issues of biomarker and selection, I guess some of my thoughts are there’s a lot of enthusiasm about immunotherapy, but we also have to be very vigilant about the immunotherapy toxicities. Some of these can creep up on you and making sure that you’re aware of them is important. And I think I’d like to see the move towards using them in earlier-stage disease because there’s more promise. I think that’s why our support of some of the trials ongoing is really critical.

Benjamin P. Levy, MD: I’d like to thank all the panelists for an excellent discussion. I’ve learned a tremendous amount from all of us here, and I think each of us has a different angle of coming in and it makes for a nice discussion for a variety of topics. So, thank you. Thank you all for contributions to this discussion. On behalf of our panel, we thank you for joining us and we hope you found this Peer Exchange® discussion to be insightful and informative.

Transcript Edited for Clarity 
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