2019 Lung Cancer Fall Preview - Episode 1
Suresh Ramalingam, MD: This is a very exciting time for the lung cancer field as a whole. We’ve seen tremendous developments in terms of how we treat patients over the past few years. And from the entire spectrum of early detection to managing a patient with advanced disease, we have good approaches that are evidence-based that can result in improved patient outcomes.
Let’s talk about metastatic disease, which is the most common disease stage at which patients are diagnosed. In patients with metastatic disease, now we clearly are approaching them in a personalized manner. We look at, do these patients have targetable mutations if they have nonsquamous histology? And if they have a targetable mutation like EGFR, ALK, BRAF, ROS1, or NTRK, we give them FDA-approved targeted therapies.
If the patients do not have a treatable target, then we treat them with immunotherapy, either by itself or in combination with chemotherapy. And whether you give chemotherapy with the immunotherapy depends on PD-L1 [programmed death-ligand 1] expression. For higher PD-L1 expression, greater than 50%, we give them pembrolizumab alone for non—small cell lung cancer. If the patient’s PD-L1 expression is low, we give them chemotherapy plus immune checkpoint inhibition.
What are the next steps? Well, it’s a very important phase of the year because we have some major meetings coming up: the World Conference on Lung Cancer in a few days, and then there’s the annual ESMO [European Society for Medical Oncology] meeting. There are some exciting trials that we’re going to hear from at these meetings. What I’m looking forward to is learning about the results of the chemotherapy plus durvalumab data in small cell lung cancer. I’m looking forward to getting an update from the LIBRETTO-001 trial with LOXO-292 in RET-positive patients.
The overall survival results of the FLAURA study are going to be presented. We’re also looking forward to the Checkmate-227 trial, which is the evaluation of ipilimumab and nivolumab in patients with advanced stage non—small cell lung cancer. I think the results we’re going to hear from these trials will have direct implications for how we manage patients, and I’m happy to discuss the implications for these trials.
Not too long ago, lung cancer was approached with a lot of therapeutic nihilism where physicians and patients didn’t feel like even treating lung cancer was worthwhile. We have turned a page on that, and we have come a long way. And now I believe lung cancer is leading the way in terms of developing new treatment options for patients, that is a model for other diseases as well. Be it targeted therapies, be it immune checkpoint inhibition, be it biomarker development, in all these fronts, lung cancer is far ahead and continues to inspire us to think about models that have worked in lung cancer to be translated in other diseases.
Transcript Edited for Clarity