Jyoti D. Patel, MD and Lawrence E. Feldman, MD, discuss second-line therapy in extensive-stage small cell lung cancer and the need for consolidative radiation, as well as the optimal sequence of therapy for a patient with non–small cell lung cancer who harbors a MET exon 14 mutation.
We recently traveled to Chicago, Illinois, for a State of the Science Summit™ on Lung Cancer.
On March 19, 2019, the FDA approved the combination of atezolizumab with carboplatin and etoposide for the frontline treatment of patients with extensive-stage small cell lung cancer. The regulatory decision was based on data from the phase III IMpower133 trial, which demonstrated a significant improvement in overall survival with the addition of atezolizumab to standard chemotherapy.
After a median follow-up of 13.9 months, the median overall survival was 12.3 months in the atezolizumab arm versus 10.3 months in the carboplatin/etoposide and placebo arm, reflecting a 24% reduction in the risk of death.
The regimen has since become the frontline standard of care for patients with extensive-stage small cell lung cancer.
Recently, on March 30, 2020, the FDA approved durvalumab for use in combination with etoposide and either carboplatin or cisplatin as first-line treatment of patients with extensive-stage small cell lung cancer. The approval is based on data from phase III CASPIAN trial, which showed a 27% reduction in the risk of death with the addition of durvalumab to standard chemotherapy. The median overall survival was 13.0 months in the durvalumab arm versus 10.3 months in the chemotherapy-alone arm. With this approval, an additional standard of care has been added to the frontline setting.
However, limited options remain for patients whose disease progresses, and there is controversy regarding whether the use of immunotherapy in the frontline setting precludes its use in the second-line setting.
In advanced non—small cell lung cancer, chemoimmunotherapy and immunotherapy alone have become standards of care in the frontline setting. While targeted therapy for patients with EGFR, ALK, and ROS1 mutations is the recommended first-line standard in the advanced setting, it’s not clear whether patients with MET exon 14 mutations can defer targeted therapy in the frontline setting in lieu of chemoimmunotherapy or immunotherapy alone.
This week, we sat down with Jyoti D. Patel, MD, professor of medicine at Northwestern University; associate vice chair for Clinical Research in the Department of Medicine at Feinberg School of Medicine; medical director of Thoracic Oncology at the University of Chicago Medicine; and assistant director for Clinical Research in the Lurie Cancer Center, along with Lawrence E. Feldman, MD, a professor of clinical medicine at the University of Illinois Cancer Center, to discuss second-line therapy in extensive-stage small cell lung cancer. In our discussion, Drs. Patel and Feldman discussed the need for consolidative radiation, as well as the optimal sequence of therapy for a patient with non—small cell lung cancer who harbors a MET exon 14 mutation.
First, we hear from Dr. Feldman, who shares a case of a 55-year-old man who presented with a right upper lobe mass and a right pleural effusion. The man underwent a CT-guided biopsy which indicated small cell lung cancer. Listen on to hear the complete case presentation that led up to his diagnosis of extensive-stage small cell lung cancer and a potential course of treatment.
Next, Dr. Patel shares a case of a 78-year-old man who presented to his orthopedist with shoulder pain. A full workup revealed a clavicular mass, right upper lobe mass, metastases in his tibia, mediastinal adenopathy, and adrenal metastases. Listen on to hear the full case presentation, the patient’s ultimate diagnosis, and the recommended course of treatment.
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