Invited discussant Christine Lovly, MD, PhD, Associate Professor of Medicine, Ingram Associate Professor of Cancer Research, Vanderbilt University Ingram Cancer Center, Nashville, discussed progress in targeted therapies for NSCLC.
“We have a tremendous amount of knowledge about driver mutations in 2021,” she said.
She noted that the recent CodeBreak100 trial found that the most common KRAS mutation, G12C, can be targeted by sotorasib.1 This mutation, formerly considered untargetable, accounts for about 13% of all lung adenocarcinoma. Multiple KRAS G12C inhibitors are now being developed.
Christine Lovly, MD, PhD
Biomarker Testing Disparities
Turning to the two abstracts she discussed, Dr. Lovly said: “The first study showed that only 50% of patients were tested for all five biomarkers by March 2020, although the use of next-generation sequencing went from 33% to 35% over the study period. The other real-world study found that White patients had higher levels of next-generation sequencing compared to Blacks, and more Whites received next-generation sequencing prior to first-line therapy compared to Blacks. Black patients were less likely to get onto a clinical trial if they had not had next-generation sequencing.”
“It’s worth noting that the frequency of EGFR and ALK alterations did not differ between White and Black patients. This is an important point. Race cannot be used as a determinant regarding which patients should or should not receive biomarker testing,” she stated.
“The data also revealed that patients whose tumors [underwent next-generation sequencing] were about twice as likely to be involved in a clinical trial. Since fewer Blacks get next-generation sequencing, that is another barrier to achieving equality and equity in clinical trial participation.”
“In 2021, we have the promise of lung cancer precision medicine. The implementation of targeted therapy is to improve outcomes. We have tremendous scientific innovation, new technologies, new biomarkers, and advancements in drug design. Implementation is a challenge. We have to apply what we already have to get equity of access while still pushing on the science front. We can’t just hit the ‘low-hanging fruit’,” she stated.
DISCLOSURE: Dr. Lovly has received honoraria from Achilles Therapeutics, Amgen, AstraZeneca, Blueprint Medicine, Cepheid, Eli Lilly, EMD Serono, Foundation Medicine, Genentech, Novartis, Pfizer, Roche, Syros Pharmaceuticals, and Takeda; has served in a consulting or advisory role for Achilles Therapeutics, Amgen, AstraZeneca, Blueprint Medicine, Cepheid, Eli Lilly, EMD Serono, Foundation Medicine, Genentech, Novartis, Pfizer, Syros Pharmaceuticals, and Takeda; has received research funding from Novartis and Xcovery; has received institutional research funding from AstraZeneca; has been reimbursed for travel, accommodations, or other expenses by Cepheid, Foundation Medicine, Genentech, Novartis, Pfizer, and Takeda.
1. Skoulidis F, Li BT, Govindan R, et al: Overall survival and exploratory subgroup analyses from the phase 2 CodeBreaK 100 trial evaluating sotorasib in pretreated KRAS p.G12C mutated non-small cell lung cancer. 2021 ASCO Annual Meeting. Abstract 9003. Presented June 4, 2021.
Even though next-generation sequencing is recommended by the National Comprehensive Cancer Network (NCCN) for biomarker testing for patients with non–small cell lung cancer (NSCLC), the uptake among community oncology practices is suboptimal, and the uptake is even lower among Black patients with...