Biomarker-Driven Lung Cancer

Three clinical trials presented at the 2019 ESMO Congress show that the tropomyosin receptor kinase inhibitor larotrectinib continues to show anti-tumor activity, including long-lasting objective responses and low toxicity, according to results from an integrated analysis.

Median overall survival was improved by 6.8 months with osimertinib as a first-line treatment for patients with&nbsp;metastatic, <em>EGFR</em>-mutant non&ndash;small cell lung cancer compared with erlotinib or gefitinib, despite crossover between arms, according to updated data from the phase III FLAURA study presented at the 2019 ESMO Congress.

A final analysis of part 1 of the phase III CheckMate 227 trial showed that nivolumab plus ipilimumab led to survival benefits in previously untreated patients with advanced non&ndash;small cell lung cancer, regardless of PD-L1 expression status.

Single-agent atezolizumab improved overall survival in newly diagnosed patients with&nbsp;wild-type non&ndash;small cell lung cancer who had &ge;50% expression of PD-L1 on tumor cells or &ge;10% expression on tumor-infiltrating immune cells compared with platinum-based chemotherapy, according to the interim survival analysis of the phase III IMpower110 study.

In an interview with&nbsp;Targeted Oncology, Tetsuya Mitsudomi, MD, summarized the major areas under investigation for the treatment of patients with lung cancer and highlighted key findings from the updated 5-year data of the KEYNOTE-001 trial.

In an interview with <em>Targeted Oncology</em>, Dean A. Fennell, MD, PhD, explained the need for the MIST trial and personalized treatment for patients with mesothelioma.

In his presentation on translational research in non&ndash;small cell lung cancer during the <em>20th Annual </em>International Lung Cancer Congress&reg;, Scagliotti, a professor of oncology at the University of Torino in Italy, discussed the promising evolution of therapeutic options, pointing to steps being taken to create a larger precision medicine ecosystem.&nbsp;

Based on findings from retrospective analyses and clinical trial data, patients with <em>ALK</em>-rearranged non&ndash;small cell lung cancer may be able to receive sequential ALK inhibitors following progression with similar second and third-generation agents.

Patients with non&ndash;small cell lung cancer on radiotherapy had a worse overall survival when a hurricane disaster was declared for their hospital than patients who did not experience a declaration, according to a study published in<em> JAMA</em>.

A matched retrospective comparison showed that progression-free survival&nbsp; in patients with advanced non-small cell lung cancer and actionable mutations was similar whether treatment went was guided with the use of tissue or circulating tumor DNA analysis with the Guardant360 assay.

Relapsed ALK-Rearranged NSCLC

Atezolizumab monotherapy demonstrated a statistically significant overall survival benefit in comparison with chemotherapy doublets in patients with untreated advanced non&ndash;small cell lung cancer with high PD-L1 expression and without <em>ALK </em>or <em>EGFR </em>mutations. This met the primary endpoint for the phase III IMpower110 trial, according to initial results release by Genentech, the developer of the PD-L1 inhibitor.

The combination of&nbsp;atezolizumab plus carboplatin and nab-paclitaxel demonstrated a clinical overall survival benefit in a subgroup of patients with&nbsp;advanced squamous non&ndash;small cell lung cancer and a high level of PD-L1 expression in the phase III IMpower131 trial. Final data for this study was presented at the 2019 World Conference on Lung Cancer.

The FDA has granted a breakthrough therapy designation to tepotinib, an investigational MET inhibitor, for the treatment of patients with metastatic non&ndash;small cell lung cancer harboring a&nbsp;MET&nbsp;exon 14 skipping alteration who have progressed following platinum-based therapy.

Treatment with selpercatinib induced responses in 68% of patients with&nbsp;<em>RET&nbsp;</em>fusion&ndash;positive non&ndash;small cell lung cancer, according to findings from the phase I/II LIBRETTO-001 trial.

Bemcentinib, a first-in-class AXL inhibitor, in combination with the PD-1 inhibitor&nbsp;pembrolizumab showed activity in patients with immunotherapy-naive&nbsp;advanced&nbsp;non&ndash;small cell lung cancer, according to findings from the phase II study presented at the 2019 World Conference on Lung Cancer.

A statistically significant improvement in overall survival was demonstrated with durvalumab, a PD-L1 inhibitor, combined with chemotherapy in patients with previously untreated extensive-stage small cell lung cancer, according to findings from the phase III CASPIAN trial, presented at the 2019 World Conference on Lung Cancer.

The FDA has granted a fast track designation to AMG 510 for the treatment of patients with previously treated metastatic non&ndash;small cell lung cancer harboring a&nbsp;<em>KRAS&nbsp;</em>G12C mutation.

In a recent analysis published in <em>JAMA</em>, data were evaluated from a collection of clinical trials and analyzed for important takeaways in the testing and treatment of patients with non&ndash;small cell lung cancer. The authors stress the importance of molecular testing in patients with NSCLC as more targeted therapies become available.&nbsp;<br /> &nbsp;

The FDA has granted capmatinib a breakthrough therapy designation as a first-line treatment for patients with <em>MET </em>exon 14 skipping mutation&ndash;positive non&ndash;small cell lung cancer.

Corey J. Langer, MD, detailed the best courses of treatment for a patient with non&ndash;small cell lung cancer to a group of physicians during a recent&nbsp;Targeted Oncology&nbsp;live case-based peer perspectives discussion.

Sarah B. Goldberg, MD, MPH, discusses the role of clinical trials in patients with lung cancer who have molecularly altered tumors, such as&nbsp;<em>EGFR</em>,&nbsp;<em>ALK</em>,&nbsp;<em>BRAF</em>,<em>ROS1,&nbsp;</em>or other alterations. These patients typically consider either targeted therapy or immunotherapy treatment options.

The review period has been extended by the FDA for a&nbsp;supplemental biologics license application for atezolizumab as a frontline treatment for patients with&nbsp;metastatic nonsquamous non&ndash;small cell lung cancer who do not have <em>EGFR</em> or <em>ALK</em> aberrations, in combination with&nbsp;carboplatin and nab-paclitaxel.