EGFR+ Lung Cancer

Tumor mutational burden has generated interest as a potential biomarker of response to immunotherapy and has already been examined in the context of several lung cancer trials to gauge its utility.

Zofia Piotrowska, MD, MHS, a medical oncologist at Massachusetts General Hospital and an instructor at Harvard Medical School, discusses the results from the phase III RELAY trial that investigated first-generation EGFR inhibitor erlotinib plus the VGEF-directed antibody ramucirumab in patients with EGFR-mutant lung cancer.<br /> &nbsp;

In an interview with Targeted Oncology, Chul Kim, MD, MPH, discussed the results from the phase I/II trial evaluating the combination of an EGFR TKI and Src inhibitor in&nbsp;<em>EGFR</em>-mutant NSCLC. He also highlighted other important advances in the treatment of lung cancer, including the evolving role of circulating tumor DNA to detect disease progression.

Dacomitinib monotherapy significantly prolonged progression-free survival in Asian patients with locally advanced or metastatic non&ndash;small cell lung cancer with epidermal growth factor receptor-activating mutations, according to results of a subgroup analysis from the phase III ARCHER 1050 study, Pfizer reported in a press release.

The FDA has accepted a Biologics License Application (BLA) for SB8, a biosimilar candidate to reference bevacizumab that was submitted by Samsung Bioepis in September 2019, according to a press release from the company.

Patients with untreated advanced EGFR-mutant non&ndash;small cell lung cancer showed an improvement in progression-free survival with the combination of gefitinib, a TKI that targets EGFR, with carboplatin plus pemetrexed compared with gefitinib alone, according to the results of the NEJ009 study.

Fred R. Hirsch, MD, PhD, discusses how genomic testing has expanded over the last few years and has impacted the lung cancer treatment paradigm.

In an interview with&nbsp;Targeted Oncology, Willemina R. Geurts-Giele, PhD, discussed the accuracy of detecting&nbsp;MET&nbsp;exon 14 skipping mutations in patients with NSCLC with DNA-based NGS panels. These findings were presented at The Association for Molecular Pathology Annual Meeting and Expo.

In a presentation describing the utility of circulating tumor DNA liquid biopsy assays at the 14th Annual New York Lung Cancers Symposium, Bob T. Li, MD, MPH, said that plasma genotyping demsonstrates practice-changing potential in non&ndash;small cell lung cancer.

Testing for driver mutations is essential before initiating therapy in patients with non&ndash;small cell lung cancer, because there is a risk that the type of upfront treatment chosen could add to the toxicity of, and spur resistance to, targeted therapy options, Suresh S. Ramalingam, MD, said at the 14th Annual New York Lung Cancers Symposium.

In an interview with Targeted Oncology during the 14th Annual New York Lung Cancers Symposium, Zofia Piotrowska, MD, MHS,&nbsp;discussed the role of osimertinib in treating patients with EGFR-mutant NSCLC and how it compares with other therapeutic options in that space.

The identification of&nbsp;<em>MET&nbsp;</em>exon 14 skipping mutations in patients with non&ndash;small cell lung cancer presents a complex diagnostic challenge that requires both DNA and RNA analysis, according to results of a University of Michigan pathology study.

Although the use of PD-1 and CTLA-4 pathway blockade in non&ndash;small cell lung cancer has had mixed results in the past, the combination of nivolumab and ipilimumab has demonstrated positive benefit in overall survival and adverse event profile compared with chemotherapy. Research suggests that anti&ndash;CTLA-4 helps induce T-cell responses and anti&ndash;PD-1 aids to restore anti-tumor T cell function.

The combination of bemcentinib, a first in class selective AXL inhibitor, and pembrolizumab is well-tolerated in patients with composite AXL-positive non&ndash;small cell lung cancer, according to updated data presented at Society for Immunotherapy of Cancer&rsquo;s 34th Annual Meeting.

According to Tina Cascone, MD, PhD, in a presentation during the 14th Annual New York Lung Cancers Symposium, neoadjuvant immunotherapy is under investigation for patients with&nbsp;non&ndash;small cell lung cancer and holds hope as a treatment for patients.

Mark G. Kris, MD, discusses treatment options for <em>MET</em>-mutant non&ndash;small cell 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.

Lecia V. Sequist, MD, MPH, director, says that oncologists have developed a better understanding of what causes resistance to EGFR inhibitors in patients with non&ndash;small cell lung cancer through preclinical studies and biopsies. <em>MET</em> amplification was found to be one of the major causes of resistance to newer generation EGFR-targeted drugs.

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;