EGFR+ Lung Cancer

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.

Nivolumab in combination with a low dose of ipilimumab demonstrated an improvement in overall survival compared with chemotherapy in patients with newly diagnosed non&ndash;small cell lung cancer whose tumors have PD-L1 expression&nbsp;&ge;1%.

The results of the phase III PACIFIC trial made a significant impact on the treat&shy;ment landscape for locally advanced non&minus;small cell lung cancer when both the progression-free survival and overall survival results were announced separately.

The FDA has approved an update to the durvalumab label for patients with unresectable, stage III non&ndash;small cell lung cancer whose disease has not progressed following concurrent platinum-based chemoradiotherapy in order to include overall survival data from the phase III PACIFIC trial.<br /> &nbsp;

Charu Aggarwal, MD, MPH, the Leslye M. Heisler Assistant Professor for Lung Cancer Excellence at Perelman School of Medicine, University of Pennsylvania, and other researchers conducted a prospective study using next-generation sequencing as a biomarker to predict response and progression-free survival rates in patients with non&ndash;small cell lung cancer &nbsp;receiving pembrolizumab monotherapy. The data were presented during the 2019 ASCO Annual Meeting.

Advances in targeted therapies show encouraging activity as treatment for tough-to-target driver alterations in non&ndash;small cell lung cancer emerge, according to data presented at the 2019 ASCO Annual Meeting. The discovery of additional oncogenic drivers and promising targeted therapies means that certain patients will receive treatments that produce favorable outcomes based on their disease characteristics.

The combination of erlotinib and ramucirumab showed better progression-free survival in patients with newly diagnosed&nbsp;<em>EGFR</em>-mutant metastatic non&ndash;small cell lung cancer compared with erlotinib plus placebo, based on findings from the RELAY trial presented during the 2019 ASCO Annual Meeting.&nbsp;

In an interview with&nbsp;Targeted Oncology, James Chih-Hsin Yang, MD discussed the updated findings from the FLAURA trial, which confirmed durable responses with frontline osimertinib in patients with&nbsp;EGFR-positive NSCLC. He highlighted what areas research will be focusing on in the coming years for patients harboring&nbsp;EGFR&nbsp;mutations.