Bright Future of Lung Cancer Research: Targeted Therapies and Immunotherapy Advancements
Expert Sandip Patel, MD, looks toward the promising future of lung cancer research, including targeted therapies, novel immunotherapy approaches, and the importance of biomarkers in guiding treatment decisions.
CASE PRESENTATION
62-year-old woman presented to the ED with vague complaints of voice changes and cough.
- She gave a history of a recent, 11-pound weight loss.
Past Medical, Family, and Social History
- Hypertension, controlled with ACEi 10 mg PO QD
- Hyperlipidemia, treated with atorvastatin 20 mg PO QD
- COPD, treated with maintenance fluticasone furoate, umeclidinium, and vilanterol (100/62.5/25 mcg oral inhalation QD)
- Mother: deceased at 65 years-of-age from lung cancer
- Former smoker: 10-15 pack years. Quit tobacco habit 25 years ago.
Physical Examination
- Current weight: 125 lbs.
- ECOG PS 1
Diagnostic Workup
- CT of Thorax: discovered a 4 cm nodule in the left, upper lobe
- CT of Abdomen reveals metastases to the liver
- MRI of Brain: negative for brain metastases
Final Pathology: consistent with squamous cell carcinoma; metastatic stage IV
PD-L1 expression by IHC: 0%
NGS: No actionable mutations
Treatment
- Therapeutic options were reviewed with the patient and family.
- She was initiated on:
- Nivolumab 360 mg IV Q3W + ipilimumab 1 mg/kg IV Q6W + 2 cycles of chemotherapy Q3W
Sandip P. Patel, MD: The future of lung cancer research is bright both in the domain of targeted therapies, using molecular testing to better understand the Achilles heels of cancer, and then adopting a targeted therapeutic approach, as well as the use of immunotherapy and novel immunotherapy targets such as TIGIT [T-cell immunoreceptor with immunoglobulin and ITIM (immunoreceptor tyrosine-based inhibitory motif) domain] or novel therapeutic modalities such as antibody-drug conjugates, which will help us increase our therapeutic armamentarium and determine the best particular option for a given patient. I think as we get more options, the importance of understanding the biomarker story for a given patient so we can best guide them on the appropriate treatment for the therapeutic journey remains key.
The ability for us to use a molecular map or an immunologic map in the form of next-generation sequencing, PD-L1 status, and hopefully other biomarkers to help guide the patient toward their best therapy will be key. We’re really looking forward to the ability for us to better understand which patients benefit from a particular immunotherapeutic strategy as we advance targeted therapy through the use of next-generation sequencing, in particular, liquid biopsy. Hopefully we’ll have similar multimodal tools to better understand the patient’s immune system so we can best adopt a particular immunotherapeutic strategy for the benefit of our patients.
Transcript is AI-generated and edited for readability.
