Millie Das, MD
Within the non–small cell lung cancer (NSCLC) population, patients without known molecular drivers make up the majority of cases, explains Millie Das, MD. However, studies are investigating more regimens to improve the efficacy for these patients.
For example, the ongoing ECOG E-5508 trial is studying bevacizumab (Avastin) and pemetrexed disodium alone or in combination following induction therapy with carboplatin/paclitaxel/bevacizumab to determine whether outcomes are improved in treating patients with advanced nonsquamous NSCLC (NCT01107626).
Additionally, next-generation sequencing platforms are evolving to detect some of the less-common molecular alterations in patients without EGFR
, or ROS1
, and RET
“The goal is to identify more of these driving genetic alterations and to come up with treatments that we can target,” said Das in an interview during the 2017 OncLive®
State of the Science SummitTM
on Advanced Non–Small Cell Lung Cancer.
Das, a clinical assistant professor of medicine – oncology at Standard Medicine, explained the difficulties of the non-driver NSCLC patient population, interesting clinical trials that could reshape therapeutic options, and her belief that these patients do have molecular targets that have yet to be identified.
OncLive: What did you highlight regarding these patients with non-driver NSCLC?
I discussed the treatment options for the majority of our patients who actually don’t have known driver genetic alterations. I talked about the data for chemotherapy and targeted agents—pemetrexed as a frontline option, but also as a maintenance option for our patients. I reviewed the data for bevacizumab, as well, to look at it in the frontline and maintenance settings, and touched upon some of the recent data with necitumumab (Portrazza) and ramucirumab (Cyramza) that have gained FDA approval in the treatment of lung cancer.
How do you currently use bevacizumab? Can you use it in both the frontline and maintenance settings for a patient?
For bevacizumab, the main thing is the patient selection. In the upfront setting, you would want to think about it for patients with good performance status. We know that the ECOG E-4599 study that looked at bevacizumab examined it in ECOG performance score 0 and 1 patients. These are really fit and likely younger patients. We know that, with patients over the age of 70, there is a higher risk of toxicity—so you want to be mindful of that. For patients who are having ongoing hemoptysis, you’re not going to want to offer that.
Again, patient selection plays a very important role. [You need to be] talking to the patient about the additional benefit with the addition of bevacizumab to standard chemotherapy, discussing the increased risks and the benefits, and involving them in the decision to add that as part of their treatment strategy.
Are there combination regimens being explored with bevacizumab?
That is an area of ongoing interest and research. The ECOG E-5508 study is looking to see whether the combination of pemetrexed and bevacizumab as maintenance treatment after upfront treatment with carboplatin/paclitaxel/bevacizumab is any better than maintenance bevacizumab alone or maintenance pemetrexed alone. That will be a really interesting study to see what that shows in the end.