EGFR+ Lung Cancer

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.

Findings from a phase II study in patients with small cell lung cancer suggested tumor immune phenotypes can be predictive of response to immune checkpoint blockade. Responses to the combination of durvalumab plus olaparib were observed in all patients where tumors had an inflamed phenotype.

Lowell L. Hart, MD, FACP, scientific director of clinical research, Florida Cancer Specialists & Research Institute, and associate professor of medicine, Wake Forest University School of Medicine, discusses the effect of CDK4/6 inhibitor, trilaciclib on myelosuppression in patients with previously treated extensive-stage small cell lung cancer receiving topotecan. Hart presented the phase II results from the blinded, multicenter study during the 2019 ASCO Annual Meeting.

The addition of carboplatin and pemetrexed to therapy with gefitinib in patients with non&ndash;small cell lung cancer and an <em>EGFR</em>-sensitizing mutation had a statistically significant effect on progression-free survival and overall survival and represents a new therapy option for these patients.

A 61-Year-Old Man With ALK-Rearranged NSCLC

During the <em>20th Annual </em>International Lung Cancer Congress, <em>Targeted Oncology</em> spoke with another Lung-MAP investigator, Fred R. Hirsch, MD, PhD, about the status and importance of the trial and new recommendations for molecular testing and liquid biopsies working their way into practice in the lung cancer field.

The combination of durvalumab and tremelimumab did not meet its primary overall survival endpoint compared with platinum-based chemotherapy in patients with previously untreated stage IV non&ndash;small cell lung cancer and a high tumor mutational burden, according to final OS results from the phase III NEPTUNE trial.

Twenty to 30 years ago, delivering a diagnosis of lung cancer to a patient was a difficult conversation to have for many oncologists. But that has given way to greater optimism today, according to Mark A. Socinski, MD.

The FDA has approved entrectinib for the treatment of adult patients with <em>ROS1</em>-positive metastatic non&ndash;small cell lung cancer. An accelerated approval was also granted to entrectinib for the treatment of adult and adolescent patients with solid tumors harboring an <em>NTRK </em>gene fusion and who have no alternative, effective therapies available.

Heather A. Wakelee, MD, discusses recent research investigating antiangiogenic agents and checkpoint inhibitors in the frontline for patients with <em>EGFR</em>-positive non&mdash;small cell lung cancer. The most promising data were demonstrated in the phase III IMpower150 trial.

Although chemotherapy remains the standard treatment for small cell lung cancer in first- and second-line settings, notable progress in immunotherapies have recently taken place, begging the question of how these agents will be optimized in this tumor type.

During an interview with <em>Targeted Oncology</em>, Charu Agarwal, MD, reviewed the findings of a prospective study of pembrolizumab monotherapy in patients with advanced NSCLC.

Osimertinib has demonstrated a statistically significant and clinically meaningful improvement in overall survival compared with standard first-generation EGFR tyrosine kinase inhibitors in patients with newly diagnosed <em>EGFR</em>-mutated non&ndash;small cell lung cancer, according to updated findings from the phase III FLAURA trial.

During a recent&nbsp;<em>Targeted Oncology&nbsp;</em>live case-based peer perspectives presentation, Corey J. Langer, MD, discussed with a group of physicians the diagnostic workup and the considerations for treatment he makes when seeing a patient with non&ndash;small cell lung cancer in the clinic. Langer, director of thoracic oncology, Abramson Cancer Center, and professor of medicine, Hematology/Oncology Division, University of Pennsylvania, reviewed treatment options based on a case study of a patient with stage III NSCLC.

Studies combining KRAS inhibitor AMG 510 several other is the start of a hopeful era for the treatment of&nbsp;KRAS-mutant non&ndash;small cell lung cancer, according to Vassiliki Papadimitrakopoulou, MD, at the 2019 International Lung Cancer Congress.

Ravi Salgia, MD, professor and chair, Department of Medical Oncology &amp; Therapeutics Research, associate director for clinical sciences, City of Hope, Durante, California, says there is a difference between precision medicine and personalized medicine.

Sequential afatinib followed by osimertinib has demonstrated a long-term overall survival of close to 4 years in patients with non&ndash;small cell lung cancer who have <em>EGFR </em>deletion 19&ndash;positive tumors and acquired T790M mutations, according to interim results released from the real-world GioTag study.

Nivolumab demonstrated long-term survival benefit in heavily pretreated patients with advanced melanoma, renal cell carcinoma, and non&ndash;small cell lung cancer, according to an analysis of 5-year results from the CA209-003 trial. The analysis also identified favorable and adverse factors associated with survival that could inform future use of nivolumab.&nbsp;

EGFR tyrosine kinase inhibitors have remained the frontline standard of care for patients with&nbsp;<em>EGFR-</em>positive non&ndash;small cell lung cancer. The most commonly used EGFR TKI in the frontline setting in the United States is&nbsp;osimertinib, Heather Wakelee, MD, said during a presentation at the 2019 International Lung Cnacer Congress.