Dr Baldonado on the Evolution of Targeted Therapy in NSCLC

Jobelle Baldonado, MD, thoracic surgeon, Moffitt Cancer Center, discusses efforts to develop more personalized approaches for treatment in non–small cell lung cancer (NSCLC), as well as how earlier testing may improve treatment benefit with targeted therapies in this space.

The landscape of personalized treatment approaches in lung cancer has seen significant advancements in recent years, particularly with the emergence of targeted therapies following trials like the phase 3 ADAURA trial (NCT02511106), Baldonado begins. This trial evaluated the efficacy of adjuvant osimertinib (Tagrisso) in patients with early-stage, resected NSCLC harboring EGFR mutations, including EGFR exon 19 deletions or exon 21 (L858R) mutations.

Findings from the ADAURA trial were highly significant, demonstrating a significant improvement in disease-free survival (DFS) with adjuvant osimertinib compared with placebo in this population. The trial also showed a reduction in the risk of disease recurrence or death with osimertinib, supporting the agent's approval by the FDA as an adjuvant treatment for patients with early-stage EGFR-mutated NSCLC in 2020.

This trial, along with others, has paved the way for the development of targeted therapies addressing various mutations such as EGFR, ALK, and KRAS, as well as novel treatment modalities like antibody-drug conjugates, Baldonado adds. These advancements mark the beginning of a new era in personalized medicine, offering tailored treatment options based on individual tumor characteristics, she emphasizes.

The introduction of targeted therapies indicates the potential for improved patient outcomes in advanced lung cancer, Baldonado continues. However, the expansion of personalized treatment approaches to early-stage lung cancers is highly anticipated, she says. Surgeons, who often encounter patients with early-stage disease, are anticipating the day when patients can undergo testing for targeted therapies to potentially prevent disease recurrence post-curative therapy, Baldonado explains. The prospect of offering targeted drugs even to patients with stage I disease holds promise for enhancing treatment efficacy and ultimately improving patient outcomes across all stages of lung cancer, Baldonado concludes.