Future of NTRK Fusions

John L. Marshall, MD: Luis, let me give you a chance to opine on this as well. You’ve reflected a lot on the testing and the new medicines that are coming. What are your thoughts about the future with these agents, either alone or in combination?

Luis E. Raez, MD: This is very important. I don’t get discouraged because there are low percentages. We have more than 225,000 new lung cancer patients this year. If you calculate that in America, we should be able to treat around 8000 patients with all the cancers together with NTRK fusion. I think we should find them.

The other thing I don’t understand is why our payers do not encourage testing, not only for NTRK fusions but for everything, because a lot of people say these are expensive drugs. You see how much we bill for 1 cycle of chemoimmunotherapy. It’s 2 or 3 or 4 times of the cost of targeted therapy.

If I were the medical director of an insurance company, I would require that every cancer patient gets NGS [next-generation sequencing] done, because I can show that it’s going to save money. Maybe they are not interested in doing that. But that would be a cost-effective way to save money to put people on targeted therapy.

Also, the quality of life is most important, because if you’re going to be with an NTRK fusion for 28 or 30 months before you progress, you save a lot of money on hospitalizations and all the other issues. That’s why we should advocate the cost-effective benefit for our patient, on top of the amazing quality of life they get with targeted therapy.

John L. Marshall, MD: Yeah. Mark, I’ve left you in the most difficult position. After all these smart comments, set the stage for our marching orders as we go forward. You’ve been in the lead on much of this throughout your career, driving things in lung cancer, really helping to transform the business there and educating so many of us about this. Are you excited about what’s going on here? What’s some advice you’d like to share with our audience?

Mark A. Socinski, MD: Yeah. I thank my colleagues. All 4 of you gave great insight and great answers. John, the older I get, the more I take cancer very personally. For anyone on this panel, or any oncologist, if a family member—their dad, their brother—or their best friend came down with cancer, or in my case with lung cancer, the first question we would all ask is, “Did you test for NTRK in addition to everything else?”

I treat cancer as if it were a family member, and the greatest thing we can do is diagnose from oncogenic driver, because we have these highly effective therapies that work very well and work for a very long time in these patients. They’re associated with low toxicity, for the most part. It has rung true in multiple molecular alterations in lung cancer. NTRK is 1 of them.

Hopefully we’ll discover more of them. We’re beginning to understand that, yes, when resistance occurs, we have a second plan. We learned that early in lung cancer with the T790M story of EGFR, and we’re going to learn it in other cancers too. My message to community oncologists is not to let testing exhaustion get the best of you, because if all you’re going to do is find 1 patient, you’re going to make such a huge difference in the survival outcome.

Remember, every patient is connected to a family and a social situation that’s important to them, and it’s a little self-serving. These people get better, and you’re responsible for doing that. Don’t let any patient go without understanding the DNA and the RNA of that patient.

John L. Marshall, MD: What a great close. Don’t miss a chance to change somebody’s life—that is so apt. Listen, all of you—you’ve been just fabulous, and I want to thank you all for joining us today and sharing all your good insights. For the audience out there, on behalf of all of the panel, I really hope you feel that this Peer Exchange® has been useful and informative and will influence your practice.

Transcript edited for clarity.

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