Karen Reckamp, MD
In just 1 year, the treatment paradigm of non–small cell lung cancer (NSCLC) shifted dramatically in varying patient populations, especially in those with molecular abnormalities—such as EGFR
translocations, and BRAF
mutations—high levels of PD-L1 expression, and even in those without any expression of PD-L1.
“All of these changes are important today and [we need to] have discussions about the impact in the clinic, which makes a session like this so important,” said Karen Reckamp, MD, during the 2017 OncLive®
State of the Science SummitTM
on Advanced Non–Small Cell Lung Cancer.
Reckamp, associate professor and medical director for clinical trial operations, City of Hope, highlighted some of the key advancements in the lung cancer landscape in an interview during the meeting, focusing specifically on positive phase III data, recent regulatory approvals, and what research the new year is likely to bring.
OncLive: Could you reflect on recent advancements in lung cancer?
: The landscape of lung cancer treatment has changed dramatically. Even in the past year, we have a multitude of drugs that have been approved and new genes that have been identified that are potential targets for new drugs and immunotherapy.
We have experts discussing how to use these new therapies, how they impact our patients’ treatment, and we have also brought aspects of healthcare disparities into the discussion, which is really important. We find that people of minority and lower socioeconomic groups have less access to care or are less likely to get the standard of care and then have poor outcomes. All of this is incredibly important to help improve patient care that we do day in and day out to help improve outcomes for all patients who have lung cancer.
What is the importance of molecular testing?
The importance of molecular testing is that we have a number of genes that have specific targeted drugs available today. We have several genes that have drugs that are in ongoing clinical trials. Still, in many practices, people get just a handful of genes tested and, in lung cancer, that is no longer acceptable. And, we end up having not enough tissue to test, so moving toward next-generation sequencing is important. Moving toward blood-based next-generation sequencing is where we are going so that we have more access for more people, but we also need to make it affordable for everybody because it changes care in a major way.
What is the current progress with liquid biopsies?
For lung cancer, the progress with liquid biopsies has been very rapid and impactful. We have blood tests that are approved by the FDA for testing EGFR
. Again, we have multiple genes for which we have specific targeted agents. We have clinical trials that allow for liquid biopsies as the primary testing and will allow patients to go on trial based on liquid biopsies, which is groundbreaking and will help us to move away from tissue being the gold standard to being a positive test with an oncogenic driver as the gold standard.
Moving onto these specific agents, can you discuss osimertinib (Tagrisso) and the potential role that could have as a frontline agent in EGFR-mutant NSCLC?
Osimertinib is a very good drug in EGFR
-mutant NSCLC. It works very well in the brain and in T790M-mutated lung cancers; now, we have the data showing improvement in progression-free survival (PFS) for patients in the first-line setting over our standard first-generation EGFR tyrosine kinase inhibitors. There is still a question about resistance and what treatments are available following osimertinib.