Biomarker-Driven Lung Cancer

Treatment Regimen for Patients With ALK+ Non-Small Cell Lung Cancer

A 50-Year-Old Woman With ALK-Rearranged NSCLC

H. Jack West, MD, thoracic oncologist at the Swedish Cancer Institute of Swedish Medical Center, discusses the data with atezolizumab (Tecentriq) and pembrolizumab (Keytruda) in non-small cell lung cancer (NSCLC). West says that the choice of treatment is likely best left to the judgement of the physician and patient. 

The FDA approved several indications in the month of June, including venetoclax (Venclexta) in chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL), the combination of binimetinib (Mektovi) plus encorafenib (Braftovi) in melanoma, and bevacizumab (Avastin) in ovarian cancer. The FDA also accelerated approvals for pembrolizumab (Keytruda) in cervical cancer and in primary mediastinal large B-cell lymphoma, while also granting a priority review to glasdegib for acute myeloid leukemia.

A supplemental biologics license application for first-line pembrolizumab (Keytruda) for use in combination with carboplatin/paclitaxel or nab-paclitaxel (Abraxane) has been granted a priority review by the FDA for the treatment of patients with metastatic squamous non–small cell lung cancer, regardless of PD-L1 expression.

Immunotherapy may provide an opportunity to change the treatment paradigm of small cell lung cancer as new clinical trials report out in the next year, says Anne Chiang, MD, PhD. Recent results with immunotherapy agents in the second-line setting have already influenced guidelines.

Overall survival and progression-free survival were improved with the combination of frontline atezolizumab with chemotherapy compared with chemotherapy alone in patients with extensive-stage small cell lung cancer, meeting the coprimary endpoints of the phase III IMpower133 trial.

Chromosomal rearrangements involving the gene that encodes the RET tyrosine kinase are known oncogenic drivers in 1% to 2% of patients with non–small cell lung cancer. These RET rearrangements occur with characteristic partners, most commonly KIF5B, but also CCDC6, NCOA, TRIM33, CUX1, KIAA1217, FRMD4A, and KIAA1468.

Considerations for Treating Locally Advanced NSCLC

Consolidation Therapy for Locally Advanced NSCLC

A supplemental biologics license application has been accepted by the FDA seeking approval for the combination of nivolumab plus ipilimumab for the frontline treatment of patients with advanced non–small cell lung cancer with tumor mutational burden  ≥10 mutations per megabase, according to Bristol-Myers Squibb, the manufacturer of both immune checkpoint inhibitors.