Actionable Mutations in NSCLC: Expert Perspectives in Testing and Targeted Therapy - Episode 16

Closing Expert Perspectives on Treatment in Advanced NSCLC

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Lung cancer experts share final thoughts on their thorough discussion of treatments in NSCLC and what to look for in the future.

Ben Levy, MD: I want to thank you all for this rich and informative discussion. Before we conclude, maybe we can get some parting shots from each of you. Briefly, Misako, what are your closing thoughts on our discussion today?

Misako Nagasaka MD, PhD: So many new agents have come out in the past decade. I’m privileged to be specializing in lung cancer at this exciting time. As Dr Dietrich mentioned, the goal is always going to be trying to get better efficacy and tolerability to ultimately lengthen survival without damaging the quality of life of our patients, and selecting the right patients for the right treatment at the right time is going to be key.

But first, if we can’t identify these targets, we can’t offer them the best effective therapy or clinical trials that might increase their chances of response. Patients, providers, payers, and the whole community need to understand the importance of broad molecular testing and advocate for it so that it can be done in an efficient and speedy manner without giving cost headache issues to the patients. I’d also like to advocate for clinical trials and being more inclusive in enrolling the diverse patient population that we serve. It’s the courage of the individual patients who go on these clinical trials that ultimately moves science forward. I’m open to doing everything we can to make clinical trials more accessible to patients. Thank you for having me. I really enjoyed the discussion.

Ben Levy, MD: Thank you, Misako. Tim, your closing thoughts?

Timothy Craig Allen, MD, JD: I’ll second that and pile on a little. Taking a big step back here, I’m a firm believer in equity for all of our patients. We’re talking about amazing things here, but I also recognize that there’s a large number of patients with lung cancer who aren’t being tested or are being tested and the results aren’t back in time for therapeutic value. We want to work toward that equity. Getting our community patients more involved in trials is a big first step. Academics working in a molecular tumor board fashion with our colleagues who are on the front lines with their patients in community settings may be valuable, too.

Oddly enough, as we talk about amazing science here, it often comes down to the logistics of the payers, getting the tissue adequately, or getting the tissue submitted to the right place at the right time, which seems to be a big headache. We’ll continue to address those challenges moving forward, because our patients deserve to have testing and opportunities for these great therapies wherever they are. Thank you again for the invitation. It has been a delight.

Ben Levy, MD: Thanks, Tim. Well stated. Martin, what are your thoughts?

Martin Dietrich, MD: I second what has been said. The most important part and the fastest way to improve lung cancer care is to apply what we do. The publications we’ve seen at last year’s ASCO [American Society of Clinical Oncology annual meeting] were very courageous to admit that a third of our patients aren’t getting proper standard of care based on missing biomarker testing. That’s self-critical data that needed to be out in the public domain. We need to do better there.

My main thought, which we haven’t touched on very much, is that we’re going to be entering a multidimensional universe of biomarkers for each patient. This isn’t going to be a binary world of EGFR mutant or wild type, but it’s going to be secondary mutations, immunophenotypic markers that are complementing each other. Understanding them is going to [become] tremendously complex. Finding pathways of not only getting the testing but getting the testing properly interpreted and applied and using evidence-based algorithms to understand the patient’s needs, sometimes with difficult assessments in more or less new spaces and data poor zones, is going to be critical. It’s going to get more complex, and there isn’t going to be an easy answer that’s going to make this happen.

Getting infrastructure in place to not only obtain but also crystallize the data is going to be key, along with molecular tumor boards and industry collaboration. Many of the commercial providers have done a tremendous job in making this happen, accessing this information, and submitting them for data. We have an internal molecular tumor board that’s heavily utilized. Those are important components that you need if you want to practice good lung cancer care in the future.

Ben Levy, MD: Hatim?

Hatim Husain, MD: What this panel discussion has shown me is that there’s such a clear emphasis on the molecular strategy in lung cancer. Lung cancer is truly a disease of dysregulated genes. Embracing and understanding that, and getting the appropriate molecular profiling done is a core essential pillar of the treatment of lung cancer. That’s where we are in 2022. We have more genes than we’ve ever had in a targeted strategy in the frontline management of lung cancer.

It’s important to make sure the patients are adequately tested. As we’ve discussed in this panel, across each of the genes, there are many options. The field is vetting out each option for its pros, cons, efficacy, brain efficacy in the CNS [central nervous system], and tolerability. One of my former mentors once told me that a medicine is good insofar as we know whom to give that medicine to. Lung cancer emphasizes the biomarkers as much as our understanding of the medicines. We need to improve and disseminate as much information as possible about tissue and liquid analyses because they parallel the efficacy of the medicines.

Ben Levy, MD: Fernando?

Fernando C. Santini, MD: If I can add something after that, I’ll just add another layer of complexity. If we move everything to early stage lung cancer, we still have much to learn about oncogene-driven treatment in this setting.

Ben Levy, MD: We didn’t even get to touch on where we’re heading in early stage, given how much data we have in the advanced stage. A lot of you have said this: No. 1, we need to remember it takes a village to treat patients. It’s not just the medical oncologist, pathologist, interventional radiologist, interventional pulmonologist, surgeon, and radiation oncologist. It’s also the nurse navigator, nurse practitioner, palliative care and supportive care team, and social worker. All those play key roles for our patients. We need to remember that it can’t just be 1 person.

With clinical trials, what Misako said about this is important. We wouldn’t have all these great data unless we had the clinical trials to bring forth these drugs to put them into our clinical practice. It’s a very exciting time. We need to remember that clinical trials play a critical role in moving this field forward. They’re getting more difficult to do. There’s a lot of complexity and coordination, but they need to be done.

Thank you once again to our panel. To our viewing audience, thank you for joining us. We hope you found this OncLive® Peer Exchange discussion to be useful and valuable to the treatment of your patients with lung cancer. Thanks again.

Transcript edited for clarity.