Dr Bleiberg on Shared Decision-Making in EGFR-Mutated NSCLC

"Discussing with patients how they may feel, or even how they may look to other individuals and their caregivers, can be really helpful when determining which route is the right choice for the right patient… In SCLC, [ADCs] have the potential to really redefine how we manage the second-line setting for our patients with a disease for which there was previously few options."

Benjamin Bleiberg, MD, an assistant professor in the Department of Hematology/Oncology at Fox Chase Cancer Center, discussed how shared decision-making conversations can guide frontline treatment selection for patients with EGFR-mutant non-small cell lung cancer (NSCLC), in addition to highlighting the development of antibody-drug conjugates (ADCs) in small cell lung cancer (SCLC) at the 21st Annual New York Lung Cancers Symposium.

In the first-line EGFR-mutant setting, one of the major decisions patients face is between a bispecific antibody–based targeted regimen and chemotherapy plus an EGFR-directed TKI, Bleiberg explained.

The toxicity profiles of these regimens are clearly distinct, Bleiberg said. Chemotherapy-containing treatment is associated primarily with hematologic toxicities, and some patients have concerns about receiving chemotherapy, he noted. In contrast, dermatologic toxicities predominate with bispecific therapy, he added. For this reason, Bleiberg said, talking through how each regimen may affect how patients feel and how they appear to others, including their caregivers, can help when determining which approach is right for a given patient.

Looking ahead, Bleiberg pointed to ADC development in SCLC as an area he is particularly excited about. Although ADCs are increasingly being employed in NSCLC, they have the potential to redefine how SCLC is managed, particularly in the second-line setting, where options were previously limited, he said. According to Bleiberg, several B7-H3– and SEZ6-directed ADCs are under development, with trials actively accruing. Phase 3 data from US-based or international studies will be key to informing how and where these agents fit into the SCLC treatment paradigm, Bleiberg concluded.