Presenters Seek to Answer Practical Questions of Lung Cancer Management at 2020 Winter Lung Meeting

Heather A. Wakelee, MD

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™ 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.

Internationally recognized faculty members will provide presentations addressing practical questions that arise on a daily basis in the management of patients with lung cancer and will answer further questions from the audience throughout the course of the meeting.

In an interview withTargeted Therapies in Oncology, meeting co-chair Heather A. Wakelee, MD, discussed several major trends in lung cancer research that are quickly evolving and the related questions that need to be answered when seeking to treat patients with these newer approaches.

“The meeting has always strived to look at what’s happening in lung cancer across different stages of disease with all of the newest developments over the [past] year,” said Wakelee, a professor of medicine at the Stanford University Medical Center as well as the faculty director of the Stanford Cancer Clinical Trials office. She said that immunotherapy has clearly been established as a standard treatment for patients with metastatic disease who do not harbor a molecular driver of their disease, and that many developments have been made recently in the context of immunotherapy treatment for lung cancer.

“I think the biggest radical changes would go back a year-and-a-half, which are the chemotherapy plus immunotherapy regimen [in the] first line, and then the PACIFIC study, where you’re giving immunotherapy after chemoradiation. Those are the most practice-changing,” Wakelee said, highlighting the improvements in outcomes both regimens have induced in their respective settings.

However, as new findings arise about immunotherapy treatment in lung cancer, just as many new questions crop up. Answering many of these questions about immunotherapy will be a key area of discussion on Saturday, February 8, during the Winter Lung meeting.

Presenters will first seek to answer when immunotherapy should be started, for which patients and in which settings of disease, as well as when treatment should end and even, potentially, be restarted. Wakelee acknowledged that a great deal of current research in immunotherapy revolves around boosting the immune-altering potential of such drugs. “The challenge we face now is what do we do when those drugs stop working…there are dozens of trials that explore what we can do when immune therapy stops working, how we can get these agents to work better, and what we can tweak in the immune system itself to make it respond better to more than just single-agent checkpoint inhibitors.”

One approach to boosting outcomes with immunotherapy is its integration with other treatment modalities such as chemotherapy, radiotherapy, and surgery. The PACIFIC trial, which investigates immunotherapy following chemotherapy and radiation for improved outcomes, is a prime example. The second module of the day will focus on multimodality treatment options for patients with lung cancer.

The esteemed presenters and panelists at Winter Lung will also discuss surgical issues relating to the use of immunotherapy. It is here that the current early data surrounding neoadjuvant and adjuvant immunotherapy use will be discussed in detail. But as the clinical trials are still in the early stages, many questions remain about how much of a benefit these approaches will provide, and which patients will be eligible for neoadjuvant/adjuvant treatment.

Wakelee herself is quite eager to see further results of the studies of adjuvant and neoadjuvant immunotherapy: “We’ve yet to see the survival details from those trials, but we’re seeing some encouraging preliminary data…[and] that’s going to have an impact [on changing] cure rates for a lot of people.” She is currently involved in several such trials and explained that they are among the pursuits she is most excited about right now.

Emerging and established molecular drivers of lung cancer, along with the targeted therapies that treat them, are another area of focus driving lung cancer research at the moment. They comprise the majority of the Winter Lung meeting’s agenda for Sunday, February 9.

“Every few months it seems we’re hearing about new targeted agents,” Wakelee said, highlighting the KRAS-targeted agent AMG 510 as the newest agent everyone is talking about for its ability to reach a target that was previously believed to be “undruggable.” Currently, she says, about 15 targeted agents are available to treat patients with molecularly driven disease, and that number is expected to grow. Benjamin P. Levy, MD, will give a presentation during the meeting on recent data with such newer agents, including AMG 510, and what physicians should know about these emerging therapies for their patients with these rare alterations.

New agents are also emerging to treat the more standard driver mutations and alterations, such asEGFR,ALK, andROS1; the National Comprehensive Cancer Network and other guidelines recommend testing for these in all patients with lung cancer. The emergence of more such agents can spur further questions about what to give to a patient with these alterations: the standard of care, something new, or a combination?

Faculty will seek to resolve when standard targeted therapies should be given, how to choose among the available agents, and how to determine if further treatment is needed, such as in the setting of resistance to standard tyrosine kinase inhibitors. Discussion will also cover the role of PD-L1 expression and immunotherapy in patients with molecularly driven disease and further testing for such patients.