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Take-Home Messages on the NSCLC Treatment Paradigm

Panelists: Benjamin P. Levy, MD, Sibley Memorial Hospital; Sanjay Popat, PhD, FRCP, Imperial College London; Solange Peters, MD, PhD, Centre Hospitalier Universitaire Vaudois; David Planchard, MD, PhD, Institut Gustave Roussy; Suresh S. Ramalingam, MD, Winship Cancer Institute
Published: Thursday, Oct 18, 2018



Transcript:

Benjamin P. Levy, MD:
We’re going to wrap up. This has been a great discussion. Before we conclude this Peer Exchange, I’d like to ask each of you to provide some final insights based on what we have just covered. Solange, I’ll put you on the spot first. Do you have any final parting thoughts?

Solange Peters, MD, PhD: I think we’ve been developing what we aim to call, and we like to call, precision oncology. All these drivers that we are describing move frontline therapy forward in naïve patients with targeted therapy. It’s amazing. But beyond that, we can treat the other patients who are not characterized with such a tumor with new, very interesting drugs, which are immunotherapies. My note here will be that we still don’t deliver precision immunotherapy. We struggle with PD-L1, we still don’t know how to implement TMB [tumor mutational burden], and we end up giving a triplet to all patients. I think we have been moving to precision oncology for drivers. We need to move to precision oncology for immunotherapy in order to spare cost and create access for all the patients.

Benjamin P. Levy, MD: A need for biomarkers, good point. David?

David Planchard, MD, PhD: I would say I’m really impressed. I’m quite happy with the benefit of the immune treatment before chemotherapy and radiotherapy because I think we are trying to improve this population. Particularly, some of these patients can be cured by treatment. This population might develop some metastases, and clearly durvalumab brings benefit. I’m quite happy to have something efficient to propose to this population, to these patients. That’s why nowadays, we probably need to look at how to better select therapy in this population.

I’m not completely agreeing to selecting therapy for this population according to the PD-L1 status as it will be done in Europe. I’m not agreeing to selecting and not treating patient who are PD-L1–negative and not giving them access to durvalumab. This is something we might discuss. The second thing is that for metastatic disease, immune treatment is, I completely agree, a huge benefit. We should keep in mind not only to look at the PD-L1 but also to look at the molecular status of the patient before we start the treatment. Just be aware, it’s not immunotherapy for everybody. If you have a molecular alteration, you should have the privilege of going to a specific targeted therapy. That’s why we need to have the view of PD-L1 and we need to have the view of the molecular alteration of the tumor before deciding what the best treatment is for the metastatic disease.

Benjamin P. Levy, MD: Sanjay?

Sanjay Popat, PhD, FRCP: We’re living in fantastic times, aren’t we? It’s so exciting to be a lung oncologist at the moment, and it’s great to be able to offer all these amazing treatment options to our patients. Who would have thought 10 years ago that we’d have such great options? I think one of the key learnings of recent years is, as you’ve said, to really get a proper comprehensive molecular analysis of the patients, so that you know what the key drivers are, you know what the PD-L1 status is, and we might even know what the TMB status is to allow us to make the best decisions for the patients up front.

Benjamin P. Levy, MD: Final thoughts, Suresh?

Suresh S. Ramalingam, MD: I think we can all say and agree that we’re truly in the era of personalized therapy for metastatic non–small cell lung cancer. Biomarker-based selection of treatment is a reality for every patient. We have to test the patients for markers, specifically the driver mutations, PD-L1, and hopefully TMB soon. But individual therapy is here.

Benjamin P. Levy, MD: Yes, these are exciting times. Thank you all for your 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 useful and informative.


Transcript Edited for Clarity

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Transcript:

Benjamin P. Levy, MD:
We’re going to wrap up. This has been a great discussion. Before we conclude this Peer Exchange, I’d like to ask each of you to provide some final insights based on what we have just covered. Solange, I’ll put you on the spot first. Do you have any final parting thoughts?

Solange Peters, MD, PhD: I think we’ve been developing what we aim to call, and we like to call, precision oncology. All these drivers that we are describing move frontline therapy forward in naïve patients with targeted therapy. It’s amazing. But beyond that, we can treat the other patients who are not characterized with such a tumor with new, very interesting drugs, which are immunotherapies. My note here will be that we still don’t deliver precision immunotherapy. We struggle with PD-L1, we still don’t know how to implement TMB [tumor mutational burden], and we end up giving a triplet to all patients. I think we have been moving to precision oncology for drivers. We need to move to precision oncology for immunotherapy in order to spare cost and create access for all the patients.

Benjamin P. Levy, MD: A need for biomarkers, good point. David?

David Planchard, MD, PhD: I would say I’m really impressed. I’m quite happy with the benefit of the immune treatment before chemotherapy and radiotherapy because I think we are trying to improve this population. Particularly, some of these patients can be cured by treatment. This population might develop some metastases, and clearly durvalumab brings benefit. I’m quite happy to have something efficient to propose to this population, to these patients. That’s why nowadays, we probably need to look at how to better select therapy in this population.

I’m not completely agreeing to selecting therapy for this population according to the PD-L1 status as it will be done in Europe. I’m not agreeing to selecting and not treating patient who are PD-L1–negative and not giving them access to durvalumab. This is something we might discuss. The second thing is that for metastatic disease, immune treatment is, I completely agree, a huge benefit. We should keep in mind not only to look at the PD-L1 but also to look at the molecular status of the patient before we start the treatment. Just be aware, it’s not immunotherapy for everybody. If you have a molecular alteration, you should have the privilege of going to a specific targeted therapy. That’s why we need to have the view of PD-L1 and we need to have the view of the molecular alteration of the tumor before deciding what the best treatment is for the metastatic disease.

Benjamin P. Levy, MD: Sanjay?

Sanjay Popat, PhD, FRCP: We’re living in fantastic times, aren’t we? It’s so exciting to be a lung oncologist at the moment, and it’s great to be able to offer all these amazing treatment options to our patients. Who would have thought 10 years ago that we’d have such great options? I think one of the key learnings of recent years is, as you’ve said, to really get a proper comprehensive molecular analysis of the patients, so that you know what the key drivers are, you know what the PD-L1 status is, and we might even know what the TMB status is to allow us to make the best decisions for the patients up front.

Benjamin P. Levy, MD: Final thoughts, Suresh?

Suresh S. Ramalingam, MD: I think we can all say and agree that we’re truly in the era of personalized therapy for metastatic non–small cell lung cancer. Biomarker-based selection of treatment is a reality for every patient. We have to test the patients for markers, specifically the driver mutations, PD-L1, and hopefully TMB soon. But individual therapy is here.

Benjamin P. Levy, MD: Yes, these are exciting times. Thank you all for your 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 useful and informative.


Transcript Edited for Clarity
View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: Oncology Best Practice™ Decision Points in Advanced NSCLC: Assessing Treatment Options Beyond Disease ProgressionNov 30, 20181.0
Community Practice Connections™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer CareNov 30, 20181.0
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