Biomarker-Driven Lung Cancer

In an interview with&nbsp;<em>Targeted Oncology</em> during the <em>14th Annual </em>New York Lung Cancers Symposium, Benjamin P. Levy, MD, discussed therapeutic strategies for patients with oncogenic-driven and nondriver NSCLC.

Noeadjuvant therapy for lung cancer provides significant benefits compared with adjuvant therapy, according to&nbsp;Jamie E. Chaft, MD. In a presentation at the&nbsp;<em>14th Annual </em>New York Lung Cancers Symposium, Chaft explained why neoadjuvant therapy is beneficial even though adjuvant therapy is still the standard of care at a number of cancer centers.

Laura Quan Man Chow, MD, FRCPC, discusses the rationale for evaluating ceritinib in patients with&nbsp;<em>ALK</em>-positive non&ndash;small cell lung cancer in the ASCEND-7 trial.

Despite advances in small cell lung cancer, overall 5-year survival remains at 5% to 10%. At the time of presentation, approximately 30% of patients with SCLC have limited stage disease, which is confined to the mediastinum, the hemithorax, or the supraclavicular lymph nodes. The remaining patients, who have extensive-stage SCLC, have tumors beyond the supraclavicular areas.

With so many advances occurring in the field of lung cancer and guidelines changing on an almost monthly basis, keeping up with the latest best practices has become more challenging for many oncologists. The 17th Annual Winter Lung Cancer Conference&trade;&nbsp;taking place February 7-9, 2020, in Miami, Florida, seeks to inform oncologists and healthcare professionals about the most up-to-date research and management suggestions.

In an interview with <em>Targeted Oncology</em>, Suresh S. Ramalingam, MD, deputy director of Winship Cancer Institute of Emory University, discussed the updated OS results from the FLAURA trial and evaluated the role of osimertinib in patients with <em>EGFR-</em>mutant NSCLC. He also highlighted some next steps with research for this patient population, such as the potential combination of osimertinib with other agents.

The FDA has approved a supplemental New Drug Application for a single dose of aprepitant injectable emulsion for intravenous use in patients receiving moderately emetogenic chemotherapy. The approval expands the dose for aprepitant to include a 130 mg single-dose regimen for the prevention of acute and delayed chemotherapy-induced nausea and vomiting.<br /> &nbsp;

Nivolumab in combination with low-dose ipilimumab and concomitant chemotherapy demonstrated a benefit in overall survival compared with chemotherapy alone in patients with previously untreated advanced non&ndash;small cell lung cancer, according to interim results from the CheckMate -9LA trial.

The lack of approved therapies to target EGFR exon 20 insertion mutations, the third most common form of EGFR mutations, led to the study of osimertinib in combination with cetuximab in patients with advanced EGFR-mutant non&ndash;small cell lung cancer.<br /> &nbsp;

In a&nbsp;Targeted Oncology&nbsp;case-based peer perspectives live discussion with a group of physicians, Corey J. Langer, MD, reviewed the potential for treatment with immunotherapy following chemoradiotherapy for patients with stage III non&ndash;small cell lung cancer. Langer discussed these options based off of a case scenario of a patient with stage IIIA lung adenocarcinoma.

Emerging from the recent 2019 World Conference on Lung Cancer&nbsp;are several notable developments, Robert L. Ferris, MD, PhD, wrote in this issue of&nbsp;<em>Targeted Therapies in Oncology.&nbsp;</em>

Patients with treatment-na&iuml;ve EGFR-mutant non&ndash;small cell lung cancer experienced a statistically significant and clinically meaningful improvement in progression-free survival with the combination of ramucirumab and erlotinib compared with erlotinib alone, according to the results of the phase III RELAY trial which was recently published in The Lancet Oncology.

In an interview with&nbsp;Targeted Oncology, Luis Paz-Ares, MD, PhD, discussed the findings for the CASPIAN trial that were presented at the 2019 ESMO Congress. He also addressed what next steps are necessary to further develop the durvalumab combination in this setting.&nbsp;

Advances in the development of targeted therapies and the identification of emerging biomarkers of response to treatment have led to an improved ability to predict and enhance responses to immunotherapeutic agents in non&ndash;small cell lung cancer.

Four patients with lung adenocarcinoma with NRG1 fusions demonstrated some degree of response or tumor stabilization when given afatinib, according to a poster presentation at the 2019 World Conference on Lung Cancer meeting. The findings suggest that the irreversible pan-ERBB inhibitor is a potential treatment in this rare mutation of lung adenocarcinoma.

Findings from part 1 of the phase II/III RESILIENT trial of irinotecan hydrochloride liposome injection in second-line treatment of small cell lung cancer showed that for close to 50% of patients, disease control was maintained at 12 weeks. These data were presented at the 2019 World Conference on Lung Cancer.

In a presentation at the 2019 ESMO Congress on a case series of 7 pretreated patients with <em>NRG1</em>-positive tumors, Stephen Liu, MD, and colleagues discussed the efficacy of afatinib and explained that afatinib may be a potential treatment option for <em>NRG1</em>-positive tumors across multiple cancer types.

In an interview with&nbsp;<em>Targeted Oncology</em>, Negrao, assistant professor, The University of Texas MD Anderson Cancer Center, reviewed data from the study of response to ICB therapy in patients with oncogene-driven non&ndash;small cell lung cancer.

At the recent <em>20th Annual </em>International Lung Cancer Congress&reg; in Huntington Beach, California, a number of very prominent contributors to the lung cancer translational and clinical field provided updates regarding novel strategies to address unmet needs.

The wealth of new data available for the treatment of patients with non&ndash;small cell lung cancer has led to numerous effective immunotherapy combinations in similar patient subsets, explained Karen L. Reckamp, MD, MS. Clinical trials going forward seem to primarily focus on the combination of immunotherapeutic and targeted agents, which may result in even more options for this tumor type.

Multiple presentations at the 2019 ESMO Congress add to the evidence that blood-based biomarkers have predictive utility in advanced non-small cell lung cancer. Blood-based next-generation sequencing has also shown clinical utility in aiding treatment decisions for physicians treating this disease.

Following the 2019 ESMO Congress, experts across various fields highlighted some next steps and how these treatment options will improve the treatment landscape for patients with ovarian, lung, breast, GI, or GU cancers. Overall, the abstracts presented at this year&rsquo;s meeting will change the treatment paradigm in a number of patient populations.

The introduction of<strong> </strong>CDK4/6 inhibitors for the treatment of hormone receptor&ndash;positive, HER2-negative breast cancer has transformed therapy management and extended survival for this patient population. The next step in the process of tailoring therapy towards individual patients is the introduction of targeted therapies for patient subsets with driver aberrations.

The multikinase inhibitor entrectinib induced frequent and durable responses, which often deepened over time, in patients with <em>ROS1</em>-positive and&nbsp;<em>NTRK</em>-positive non&ndash;small cell lung cancer, according to an integrated analysis of 3 clinical trials.

The addition of direct oral oral anticoagulants for the management of venous thromboembolism in patients with cancer is the latest change to previous guidelines issued by the American Society of Clinical Oncology.

In the phase III CASPIAN study, durvalumab added to etoposide and platinum-based chemotherapy delayed the development of new lesions and improved patient-reported outcomes compared to etoposide and platinum-based therapy alone in untreated patients with extensive-stage small cell lung cancer.

Using a measure known as the growth modulation index, patients with TRK fusion&ndash;positive cancers who were treated with larotrectinib had a clinically meaningful improvement in progression-free survival compared with the time to progression on their prior treatment, an analysis of patients enrolled in 1 of 3 clinical trials has found.

Adding PARP or CHK1 inhibitors to immunotherapies for the treatment of small cell lung cancer is the next step in the pipeline of novel combination approaches, according to Charles M. Rudin, MD, PhD, in a presentation at the <em>20th Annual </em>International Lung Cancer Congress.

Investigators have identified tumor mutational burden as a promising biomarker for predicting immunotherapy responses in patients with advanced stages of non&ndash;small cell lung cancer, but is it ready for clinical application?

Paul A. Bunn, Jr., MD, discusses subsets of patients with lung cancer that can benefit more from enrolling on clinical trials with immunotherapy compared with patients who do not benefit as much from immunotherapeutic approaches. Immunotherapy does not work in every patient, Bunn notes.