Melissa Johnson, MD, shares her goals for the first 100 days as program director of the Lung Cancer Research at Sarah Cannon Research Institute, the current state of the anti-TIGIT antibody tiragolumab, and the future of lung cancer treatment.
To kickstart her new role as program director of Lung Cancer Research at Sarah Cannon Research Institute (SCRI), Melissa Johnson, MD, has a whole host of plans in mind, some of which include strengthening the frontline clinical trial program and next-generation sequencing for patients with lung cancer at the institution.
Johnson’s new gig, which became official in January 2021, will center on leading the lung cancer clinical trial portfolio across the Sarah Cannon network; she will continue to lead the Solid Tumor Immune Effector Cellular Therapy Program at Sarah Cannon. Previously, she was the associate director of the Lung Cancer Research Program.
In an interview with OncLive, Johnson shared her goals for the first 100 days as program director of the Lung Cancer Research at SCRI, the current state of the anti-TIGIT antibody tiragolumab, and the future of lung cancer treatment.
OncLive: You're just starting in this new role at SCRI. What are you plans for the first 100 days and what are you most excited to tackle?
Johnson: I'm thrilled to assume the role of director of the Lung Cancer Research Program at Sarah Cannon Research Institute in 2021. Some of the goals that I'm the most excited about are continuing some of the work that's already ongoing. We've reached a place in lung cancer where all patients will receive chemotherapy and immunotherapy early on in their treatment for either non–small cell lung cancer [NSCLC] or small cell lung cancer.
However, we are understanding, still, that there are patients who will do really well with this strategy and will live beyond 2 years now, which is fantastic. There are others whose tumors express low levels of PD-L1, for example, or no PD-L1, whose progression-free survival is no better than it would be with chemotherapy alone.
There is the opportunity for frontline clinical research trials. Part of the opportunity there is tied up in molecular selection and profiling. We need to encourage our investigators to be doing frontline NGS on all patients with lung cancer—not waiting until they progress to start to think what else can be next.
We have increasing opportunities to treat these patients with oral targeted therapies that may actually work better than chemotherapy and immunotherapy. Therefore, strengthening our frontline clinical trial program across all the Sarah Cannon sites, and streamlining of NGS, be it in tissue or plasma, are 2 of my short-term goals for the Lung Cancer Research program.
Speaking to other efforts that SCRI is currently working on, what else in the portfolio are you interested in that can hopefully be moved further along in 2021?
In 2020, we saw the FDA approval of new targeted therapies for MET alterations as well as RET translocations in NSCLC. I predict in 2021 that we will see the approval of direct KRAS G12C inhibitors, as well as potentially new options for HER2-positive lung cancer. We have lots of efforts ongoing, not just for patients with KRAS G12C mutations in lung cancer, but for all patients with KRAS-mutant cancers in lung cancer and other solid tumors. I'm very excited for us to leverage what we're learning from the KRAS G12C–directed therapies to find direct KRAS G12D inhibitors, for example, and other combination efforts that may be more effective than the current standards of care for those patients with lung cancer.
You have been heavily involved with the research for tiragolumab, the anti-TIGIT antibody. There was a lot excitement surrounding that agent last year, and the FDA just granted it breakthrough therapy status. Where is it currently in development and what promise does tiragolumab hold in advancing the field of immunotherapy in lung cancer?
I was thrilled to see tiragolumab achieve breakthrough designation, and it does underscore this learning that has increasingly been obvious to those of us who take care of patients with lung cancer—that PD-L1 is still important.
PD-L1 predicts for patients who will do well with immunotherapy and, in particular, immunotherapy strategies like atezolizumab [Tecentriq] and tiragolumab. [The research presented at the 2020 ASCO Virtual Scientific Program] showed that patients with higher levels of PD-L1 did better with the combination than atezolizumab alone.
We'll be seeing more biomarker data at a meeting coming soon. We will be exploring what other biomarkers, such as TIGIT and PVR, might be relevant for selecting patients who might do well with this combination. However, it does seem to underscore, or emphasize, for me that PD-L1 testing is still relevant. There is valuable prognostic information there, and it's helping us achieve more personalized care for our patients.
Looking at the field of lung cancer in 2021, what are some other immunotherapy advances or other aspects to keep an eye on in lung cancer?
I love to think big like that. I'm really excited about immune effector–cell therapies for NSCLC. These days, about 20% of patients will have more than a 5-year overall survival benefit from checkpoint inhibition.
However, that's 20%, and that means that there are 80% of patients with NSCLC who still need effective therapies. I see a lot of them in the Drug Development Unit at SCRI every week. Immune effector–cell therapies are quite different. They involve taking T cells out of the patient, educating them to identify an antigen that's expressed in the tumor, and then putting those T cells back into the patient after lymphodepletion and allowing those T cells to more efficiently recognize and attack antigen on tumor cells.
There are a number of ways to do this: CAR T-cell therapy, TCR therapy, and tumor-infiltrating lymphocytes. However, we will see progress in that arena in 2021 and beyond. I'm super excited to be a part of that in our Solid Tumor Immune Effector Cellular Therapy Program at SCRI.
The environment with coronavirus disease 2019 (COVID-19) continues to evolve. Has anything changed in regard to how you handle the pandemic down in Nashville with your patients with lung cancer, especially with the emergency use authorization of 2 vaccines?
We have been fortunate at Sarah Cannon in Nashville that we were not part of the first wave in terms of COVID-19 infections. We certainly have learned a lot from our colleagues all over the country. However, we have adopted the stance of "stay safe, but stay open." Even as we, in Tennessee, are now part of the second surge of COVID-19 cases and see more infections in our hospitals in Nashville than we ever did back in March and April, we continue to put patients on clinical trials almost without missing a beat.
Of course, it has delayed access to care. That's certainly true in a place like Nashville, Tennessee that has a lot of patients who are not well integrated into any medical community or system. What we're seeing is delays in diagnosis across all of the common tumor types, and that will be something that will be impactful for many years, I'm afraid.
I don't know that we can predict all of the ramifications of this. The recent approvals of the 2 vaccines are a bright light of hope for all the health care workers all over the country, as well as first responders, teachers, and certainly patients with cancer. I'm going for my second vaccine today [January 8, 2021]. I'm super psyched, and I also feel super fortunate. I hope to convey that a successful vaccination is a critical piece of the puzzle for this country in this world, as we continue to fight this pandemic.
Is there anything else regarding your new position that you would like to highlight?
In 2020, ASCO's National Cancer Opinion Survey showed that while 75% of Americans were willing to consider clinical trials should they be diagnosed with cancer 1 day in the future, 48% of survey respondents said that patients on clinical trials do not receive the best care and are really just part of a science experiment.
That was shocking to me. As a huge proponent of clinical research at SCRI, in the community it shows me that we have a lot of education that needs to be done. We need patients to understand that they're not going to get a placebo. If they go on a trial, it will, of course be in combination with a standard-of-care agent these days. There are too many effective therapies for patients to receive sugar pills any longer.
I believe, with every fiber of my being, that the way that we're going to make progress in this field is through clinical research. I also think because the majority of patients in the United States are treated in the community, it's important that as we go forward in 2021, we recognize partnerships, academia, community oncology, and pharmaceutical and biotech companies. We need to work together. We all have strengths together; that will help us push the next great therapy. That is a long-term objective of mine.