EGFR+ Lung Cancer

<em>Targeted Oncology</em>&nbsp;spoke with experts in attendance at the 2019 ASCO Annual Meeting to review what they believed were some of the biggest takeaways from this year&#39;s presentation across the fields of lung cancer, breast cancer, GI cancers, genitourinary cancers, melanoma, and multiple myeloma.

Eric Harris, DO, hematologist/oncologist, Florida Cancer Specialists & Research Institute, gives Targeted Oncology an insiders perspective on the current state of community oncology in Florida and some ways the Florida Society of Clinical Oncology (FLASCO) aids in improving patient care by helping physicians.

Preliminary results from a phase II trial demonstrated promising activity for brigatinib in patients with non&ndash;small cell lung cancer with an&nbsp;<em>ALK&nbsp;</em>rearrangement who have progressed on treatment with another next-generation ALK tyrosine kinase inhibitor.

Alexander Drilon, MD, clinical director, Early Drug Development Service, and associate professor of the Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, discusses the data examining the role of entrectinib in patients with non&ndash;small cell lung cancer who are na&iuml;ve to treatment with a ROS1 tyrosine kinase inhibitor.

Two targeted therapies in development have demonstrated encouraging activity as potential treatments targeting hard-to-target driver alterations in lung cancer. During the 2019 ASCO Annual Meeting,&nbsp;Christine M. Lovly, MD, PhD, reviewed the early promising findings for TAK-788 for patients with&nbsp;non&ndash;small cell lung cancer harboring&nbsp;<em>EGFR</em> exon 20 insertions and for BLU-667 for patients with&nbsp;<em>RET&nbsp;</em>rearrangements.&nbsp;&nbsp;

When the targeted agents&nbsp;ramucirumab and erlotinib were combined, progression was delayed by 7 months in patients with newly diagnosed&nbsp;<em>EGFR</em>-positive non&ndash;small cell lung cancer compared to erlotinib alone, according to findings from the phase III RELAY trial.&nbsp;

Promising responses have been seen with 2 highly selective, investigational MET inhibitors&mdash;tepotinib and capmatinib&mdash;in both the&nbsp;first- and second-line setting for patients with&nbsp;<em>MET</em> exon 14&ndash;altered advanced non&ndash;small cell lung cancer.

According to a subgroup analysis from the phase III IMpower150 trial presented at the 2019 ASCO Annual Meeting, the addition of immunotherapy to&nbsp;bevacizumab and a chemotherapy doublet improved progression-free survival in patients with&nbsp;non&ndash;small cell lung cancer and baseline liver metastases.

Findings from 2 studies of patients&nbsp;with operable early-stage non&ndash;small cell lung cancer showed preoperative immunotherapy had positive activity and favorable toxicity, according to a presentation at the 2019 ASCO Annual Meeting, and phase III clinical trials are already testing these stratgies.&nbsp;

Nearly double the number of patients with advanced non-small cell lung cancer would be eligibile for clinical trial enrollment if a&nbsp;broader set of eligibility criteria proposed by the American Society of Clinical Oncology and Friends of Cancer Research was implemented,&nbsp;according to data presented at the 2019 ASCO Annual Meeting.

Single-agent lurbinectedin induced an overall response rate of 35.2% in the second-line setting for the treatment of patients with small cell lung cancer in a phase II basket trial, presented at the 2019 ASCO Annual Meeting.

The treatment of&nbsp;<em>EGFR</em>-mutant non&ndash;small cell lung cancer has experienced significant improvements with the&nbsp;development of tyrosine kinase inhibitors, but resistance mechanisms that promote disease recurrence have tampered the runaway success of these revolutionary agents, said&nbsp;Katerina A. Politi, PhD, during the 2019 ASCO Annual Meeting. Early findings are presented for 2 novel agents aiming to potentially overcome resistance.&nbsp;

Overall survival from the KEYNOTE-001 trial in patients with advanced non&ndash;small cell lung cancer showed treatment with pembrolizumab monotherapy produced more favorable rates of response at 5 years when compared with historical, pre-immunotherapy standard-of-care regimens.&nbsp;

In an interview with&nbsp;<em>Targeted Oncology</em>, experts in gynecology, gastrointestinal, genitourinary, lung, and breast cancers spoke to the significance of the abstracts they are most looking forward to at the 2019 ASCO Annual Meeting.

The NovoTTF-100L System has received approval from the FDA&nbsp;in combination with pemetrexed and platinum-based chemotherapy as a frontline treatment for patients with unresectable, locally advanced or metastatic malignant pleural mesothelioma.

Mark Socinski, MD, explained to a group of physicians at a recent <em>Targeted Oncology </em>live case-based peer perspectives presentation the treatment considerations and decisions he makes when seeing patients with non&ndash;small cell lung cancer in the clinic.

During a recent <em>Targeted Oncology </em>live case-based peer perspectives presentation, Paul K. Paik, MD, explained to a group of physicians the treatment considerations and decisions he makes when seeing a patient with non&ndash;small cell lung cancer.

Myung-Ju Ahn, MD, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, discusses the findings from the AURA LM study, which compared an 80 mg dose of osimertinib with a 160 mg dose in patients with <em>EGFR</em>-positive advanced non&ndash;small cell lung cancer with leptomeningeal metastases.

According to results from a phase IIIb interim analysis, afatinib demonstrated a predictable and manageable toxicity profile and promising efficacy in patients with <em>EGFR</em> mutation-positive non&ndash;small cell lung cancer.

Myung-Ju Ahn, MD, discusses the results from the AURA LM trial and the next steps that need to be taken in order to confirm the efficacy that was seen with the lower dose. In addition, she highlights where research in the treatment landscape of advanced NSCLC is headed.

According to findings from an exploratory analysis from the phase III IMpower150 trial presented at the 2019 European Lung Cancer Congress, atezolizumab plus bevacizumab, carboplatin, and paclitaxel has emerged as a potential new standard of care for patients with <em>EGFR</em>-positive metastatic nonsquamous non&ndash;small cell lung cancer who have failed on TKI treatment.

Nicolas Girard, MD,&nbsp;discussed the importance of evaluating durvalumab in a real-world setting. In addition, he highlights other questions that remain unanswered in this area, as well as the role of immunotherapy in patients with NSCLC.

Tony Mok, MD, discusses the next steps for pembrolizumab (Keytruda) as a treatment option for patients with non-small cell lung cancer after the phase III KEYNOTE-042 trial.

A look back at all the&nbsp;FDA news&nbsp;that happened in the month of&nbsp;April 2019, including several new approvals, a priority review, breakthrough designation, and more.

David R. Gandara, MD, discusses the treatment decisions he makes and the data that support his recommendations for treating patients with non&ndash;small cell lung cancer

Significantly higher response rates were seen in patients with&nbsp;<em>ALK</em>-positive non&ndash;small cell lung cancer who had been treated with at least 1 prior ALK tyrosine kinase inhibitor &nbsp;before receiving lorlatinib and who harbored an&nbsp;<em>ALK&nbsp;</em>resistance mutation compared with those who did not have an&nbsp;<em>ALK&nbsp;</em>mutation.

During a <em>Targeted Oncology </em>live case-based peer perspectives presentation, Josephine Louella Feliciano, MD, explained the treatment considerations and decisions she makes when treating a patient with non&ndash;small cell lung cancer in the clinic and the data that support these options to a group of physicians.

The approval of the PD-L1 22C3 pharmDX assay has been expanded by the FDA to be used as a companion diagnostic for identifying more patients with stage III or metastatic&nbsp;non&ndash;small cell lung cancer who can undergo frontline treatment with pembrolizumab.

According to new findings, tumor mutational burden showed promise as a predictive biomarker for survival benefit in patients with advanced non&ndash;small cell lung cancer (NSCLC) treated with&nbsp;the PD-L1 inhibitor durvalumab (Imfinzi) as initial therapy versus chemotherapy,&nbsp;even though there was no difference seen between the 2 treatment groups in the primary analysis of the randomized trial.

Silvia C. Formenti, MD, discusses the advantages of radiation therapy in patients with lung cancer compared to other modalities.