Undocumented Cost-of-Care Discussions: A Missed Opportunity in Cancer Treatment
A recent study underscored the need for integrating cost-of-care conversations in cancer treatment. Results of the population-based analysis, presented at the 2023 ASCO Quality Care Symposium,1 showed that only about 25% of patients with newly diagnosed advanced non–small cell lung cancer (NSCLC)...
DXH9 Depletion May Expose Small Cell Lung Cancer Tumors to Immune System Attack
Researchers may have identified a novel genetic mechanism capable of making small cell lung cancer tumors more susceptible to an attack by the immune system, according to a new study published by Murayama et al in Cancer Discovery. The findings could lead to the development of new therapeutics to...
Medicaid Expansion May Improve Postsurgical Survival Outcomes in Patients With NSCLC
Investigators have found that Medicaid expansion under the Affordable Care Act may be associated with a reduced risk of early mortality following surgical resection in patients with non–small cell lung cancer (NSCLC), according to a recent study published by Nogueira et al in JAMA Network Open. The ...
Repotrectinib in ROS1 Fusion–Positive NSCLC
As reported in The New England Journal of Medicine by Alexander Drilon, MD, and colleagues, the phase I/II TRIDENT-1 trial showed the activity of the next-generation ROS1 tyrosine kinase inhibitor repotrectinib in patients with ROS1 fusion–positive non–small cell lung cancer (NSCLC) with no...
EGFR-Mutated Early-Stage NSCLC
This is Part 3 of New Directions in Nonmetastatic Non–Small Cell Lung Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Heather Wakelee, Tina Cascone, and Marina Garassino discuss the management of EGFR-mutated early-stage non–small cell lung cancer (NSCLC). The patient is a 48-year-old woman who is being evaluated for a 3-cm mass in the right lower lobe that was detected on chest x-ray after a car accident. Biopsy confirms adenocarcinoma, and PD-L1 expression is 85%. Her brain MRI is negative. At multidisciplinary tumor board, there is a discussion of whether to start chemotherapy plus immune checkpoint inhibitor therapy immediately vs going straight to surgery given the limited extent of disease. The faculty discuss the importance of testing molecular testing for EGFR and ALK mutations prior to the start of immune checkpoint inhibitor therapy, whether adjuvant osimertinib should be continued for more than 3 years, and the clinical implications of the ADAURA and ALINA trials.
PD-L1–Negative Early-Stage NSCLC
This is Part 2 of New Directions in Nonmetastatic Non–Small Cell Lung Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Heather Wakelee, Tina Cascone, and Marina Garassino discuss the management of PD-L1–negative early-stage non–small cell lung cancer (NSCLC). The patient is a 75-year-old man who presented to his primary care provider for evaluation of worsening cough and hemoptysis. He was a smoker for 45 years, has an ECOG performance score of 1, has hypertension and COPD, and is relatively active. Chest x-ray reveals a large left lung mass, which biopsy confirms as squamous cell carcinoma. PET and brain MRI are negative, but there is a 4.3-cm lower lobe mass and a level 4L lymph node; endobronchial ultrasound does not confirm disease in any station. The final staging was stage IIA T2bN0. At a multidisciplinary tumor board, the lesion was determined to be resectable. His PD-L1 level is 0%. In the conversation that follows, the faculty discuss how treatment for early-stage lung cancer differs based on PD-L1 expression; the multidisciplinary management of immune-related adverse events; and perioperative approaches to immunotherapy.
IO Strategies for Resectable NSCLC
This is Part 1 of New Directions in Nonmetastatic Non–Small Cell Lung Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Heather Wakelee, Tina Cascone, and Marina Garassino discuss immune checkpoint inhibitor strategies for resectable nonmetastatic non–small cell lung cancer (NSCLC). The patient is an active 68-year-old woman with a 70-pack-year smoking history. On screening computed tomography, she was found to have a 3.7-cm right upper lobe mass, which biopsy confirmed as adenocarcinoma. Further staging revealed uptake in a 10R node on positron-emission tomography, but no other suspicious sites. In the conversation that follows, the faculty discuss the importance of completing staging prior to resection; how PD-L1 testing informs therapeutic strategies; and the role of neoadjuvant, perioperative, and adjuvant immune checkpoint inhibitor therapy in treating stage II/III NSCLC.
Real-World Data Show Impact of Immunotherapy in Populations Underrepresented in Lung Cancer Clinical Trials
New research published by Lee et al in JNCCN—Journal of the National Comprehensive Cancer Network found patients treated with first-line immunotherapy for advanced non–small cell lung cancer (NSCLC) had similar results in terms of overall survival, progression-free survival, and treatment duration, ...
Addition of SBRT to Standard-of-Care Systemic Therapy in Oligoprogressive Disease
In the phase II CURB trial reported in The Lancet, Chiaojung Jillian Tsai, MD, PhD, and colleagues found that the addition of stereotactic body radiotherapy (SBRT) to standard-of-care systemic therapy was associated with improved progression-free survival in the total study population of patients...
Antibody-Drug Conjugate Ifinatamab Deruxtecan Shows Robust Activity in Refractory Small Cell Lung Cancer
The antibody-drug conjugate ifinatamab deruxtecan has demonstrated “robust and durable efficacy” in patients with heavily pretreated small cell lung cancer, according to a subset analysis of the DS7300-A-J101 trial presented at the International Association for the Study of Lung Cancer 2023 World...
Phase III Trial Shows Novel Four-Drug Regimen Improves Survival Outcomes in Extensive-Stage Small Cell Lung Cancer
The addition of anlotinib to immunochemotherapy has achieved the historically longest progression-free survival and overall survival in the first-line setting of extensive-stage small cell lung cancer, according to data presented at the International Association for the Study of Lung Cancer 2023...
ASCO and Ontario Health Publish New Recommendations for Systemic Therapy in SCLC
A newly published guideline update from ASCO and Ontario Health provides evidence-based recommendations on the use of systemic therapy for small cell lung cancer (SCLC).1 Recommendations cover where novel agents fit in the treatment landscape, the management of disease in older patients with...
Neoadjuvant/Adjuvant Pembrolizumab in Resectable NSCLC
On October 16, 2023, pembrolizumab was approved for use with platinum-containing chemotherapy as neoadjuvant treatment and as single-agent adjuvant treatment in patients with resectable (tumors ≥ 4 cm or node-positive) non–small cell lung cancer (NSCLC).1 Supporting Efficacy Data Approval was based ...
EGFR-Mutated Advanced NSCLC: CNS Efficacy With Combination of Osimertinib and Chemotherapy
In a subgroup analysis from the phase III FLAURA2 trial reported in the Journal of Clinical Oncology, Pasi A. Jänne, MD, PhD, and colleagues found the combination of osimertinib and chemotherapy improved central nervous system (CNS) efficacy vs osimertinib alone in the first-line treatment of...
Advanced NSCLC: Adding Canakinumab to First-Line Chemoimmunotherapy
As reported in the Journal of Clinical Oncology by Tan et al, the phase III CANOPY-1 trial has shown no survival benefits with the addition of canakinumab to first-line pembrolizumab plus chemotherapy in patients with advanced/metastatic non–small cell lung cancer (NSCLC) without EGFR or ALK...
Lung Nodule Program May Help Detect Cancer in Patients Age-Ineligible for Lung Cancer Screening
Researchers have found that adopting a Lung Nodule Program may increase early lung cancer detection in patients who are not eligible for lung cancer screening under existing age-eligibility criteria, according to a recent study published by Liao et al in the Journal of Thoracic Oncology. ...
Encorafenib Plus Binimetinib in Metastatic NSCLC With BRAF V600E Mutation
On October 11, 2023, the BRAF inhibitor encorafenib (Braftovi) with the MEK inhibitor binimetinib (Mektovi) was approved for patients with metastatic non–small cell lung cancer (NSCLC) with a BRAF V600E mutation, as detected by a U.S. Food and Drug Administration (FDA)-approved test.1,2 The FDA...
American Cancer Society Releases Updated Lung Cancer Screening Guideline
Lung cancer incidence overall has been declining in the United States since 1992—and since 2006–2007 for both men and women by 2.7% annually and 1.1%, respectively—and overall mortality rates have declined in both men and women because of smoking cessation efforts and advances in therapy and early...
Expert Point of View: Upal Basu Roy, PhD, MPH
Upal Basu Roy, PhD, MPH, Executive Director of Research at the LUNGevity Foundation, in Chicago, shared his thoughts with The ASCO Post on the INCREASE trial’s findings and their potential impact on clinical practice. As Dr. Roy explained, neoadjuvant chemoimmunotherapy remains the current standard ...
INCREASE Trial: Immunotherapy Plus Chemoradiotherapy Doubles Complete Pathologic Response Rate in NSCLC
The integration of immunotherapy with traditional chemoradiotherapy has significantly increased pathologic complete response rates in patients with non–small cell lung cancer (NSCLC), according to data presented at the International Association for the Study of Lung Cancer 2023 World Conference on...
Antibody-Drug Conjugate Makes Progress as Second-Line Therapy for Advanced NSCLC
Datopotamab deruxtecan (Dato-DXd), a TROP-2–directed antibody-drug conjugate, improved progression-free survival by 25% on blinded independent committee review in previously treated patients with advanced or metastatic non–small cell lung cancer (NSCLC), and it was reported to be less toxic than...
Lung-MAP Trial Demonstrates Potential of Public-Private Partnerships in Advancement of Cancer Therapy
The unique public-private partnership that undergirded the Lung-MAP trial for almost a decade may serve as a model for future clinical research that is more rapid, innovative, and inclusive, according to a recent report published by Herbst et al in Clinical Cancer Research. Background The Lung-MAP...
Adding Tiragolumab to Atezolizumab and Chemotherapy in Previously Untreated Extensive-Stage SCLC
As reported in the Journal of Clinical Oncology by Charles M. Rudin, MD, PhD, and colleagues, the phase III SKYSCRAPER-02 trial showed no progression-free or overall survival benefit with the addition of the T-cell immunoglobulin and ITM domain (TIGIT) inhibitor tiragolumab to atezolizumab and...
Risk-Adapted Radioimmunotherapy for Locally Advanced PD-L1–Positive NSCLC
In the phase II SPRINT trial reported in the Journal of Clinical Oncology, Ohri et al found that a chemotherapy-sparing regimen of pembrolizumab with risk-adapted radiotherapy was associated with good outcomes in patients with stage III or unresectable stage II non–small cell lung cancer (NSCLC)...
Toxicities Potentially Linked to Combination Immunotherapy for Mesothelioma
The combination of ipilimumab and nivolumab may result in a higher levels of toxicities in patients with unresectable pleural mesothelioma than was reported in the CheckMate 743 trial, according to a recent study published by McNamee et al in the Journal of Thoracic Oncology. Background Australia...
Antibody-Drug Conjugate Makes Progress as Second-Line Therapy for Advanced NSCLC
Datopotamab deruxtecan (Dato-DXd), a TROP-2–directed antibody-drug conjugate, improved progression-free survival by 25% on blinded independent committee review in previously treated patients with advanced or metastatic non–small cell lung cancer (NSCLC), and it was reported to be less toxic than...
Novel AI Model May Predict Nonsmokers at High Risk for Lung Cancer
An artificial intelligence (AI) model may be capable of using routine chest x-ray images to identify nonsmokers who may be at high risk for lung cancer, according to new findings presented by Walia et al at the Radiological Society of North American (RSNA) 2023 Scientific Assembly and Annual...
ALINA Trial: Anticancer Activity of Alectinib Reported in Earlier-Stage, ALK-Positive NSCLC
Treatment with the anaplastic lymphoma kinase (ALK) inhibitor alectinib significantly reduced the risk of recurrence or death by 76% (P < .0001) in patients with completely resected stage IB to IIIA ALK-positive non–small cell lung cancer (NSCLC) compared with platinum-based chemotherapy. This...
Amivantamab-Based Regimens Show Anticancer Activity in EGFR-Mutated Advanced NSCLC
Widely anticipated findings from the MARIPOSA1 and MARIPOSA-22 trials were presented at the European Society for Medical Oncology (ESMO) Congress 2023, showing potentially improved outcomes with regimens incorporating the bispecific antibody amivantamab-vmjw for patients with advanced non–small...
PAPILLON: Adding Amivantamab to First-Line Chemotherapy Prolongs Progression-Free Survival in NSCLC Subset
In the phase III PAPILLON trial, the addition of the bispecific antibody amivantamab-vmjw to chemotherapy resulted in a near doubling in median progression-free survival vs chemotherapy alone in patients with untreated non–small cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR)...
Durvalumab May Offer Survival Benefit in Patients With NSCLC and Borderline Performance Status
The immune checkpoint inhibitor durvalumab may be safe and effective at improving overall survival in patients who have advanced or metastatic non–small cell lung cancer (NSCLC) and borderline performance status, according to a recent study published by Shaverdashvili et al in eClinicalMedicine....
Expert Point of View: Noemí Reguart, MD, PhD
Abstract discussant Noemí Reguart, MD, PhD, an oncologist at the Hospital Clinic Barcelona, underscored the “impressive” progression-free and overall survival results of the phase III ETER701 trial, which have “never been achieved before in extensive-stage small cell lung cancer.” According to Dr. ...
Phase III Trial Shows Novel Four-Drug Immunotherapy Regimen Improves Survival Outcomes in Extensive-Stage Small Cell Lung Cancer
The addition of anlotinib to immunochemotherapy has achieved the historically longest progression-free survival and overall survival in the first-line setting of extensive-stage small cell lung cancer, according to data presented at the International Association for the Study of Lung Cancer 2023...
Expert Point of View: Upal Basu Roy, PhD, MPH
Upal Basu Roy, PhD, MPH, Executive Director of Research at the LUNGevity Foundation, in Chicago, shared his thoughts with The ASCO Post on the INCREASE trial’s findings and their potential impact on clinical practice. As Dr. Roy explained, neoadjuvant chemoimmunotherapy remains the current standard ...
INCREASE Trial: Immunotherapy Plus Chemoradiotherapy Doubles Complete Pathologic Response Rate in NSCLC
The integration of immunotherapy with traditional chemoradiotherapy has significantly increased pathologic complete response rates in patients with non–small cell lung cancer (NSCLC), according to data presented at the International Association for the Study of Lung Cancer 2023 World Conference on...
Expert Point of View: Helena Linardou, MD, PhD
Helena Linardou, MD, PhD, Director of the 4th Department of Oncology and Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, was invited to discuss the subgroup analysis of small cell lung cancer (SCLC) in the DS7300-A-J101 trial. She first noted that the antibody-drug conjugate...
Antibody-Drug Conjugate Ifinatamab Deruxtecan Shows ‘Robust’ Activity in Refractory Small Cell Lung Cancer
The antibody-drug conjugate ifinatamab deruxtecan has demonstrated “robust and durable efficacy” in patients with heavily pretreated small cell lung cancer, according to a subset analysis of the DS7300-A-J101 trial presented at the International Association for the Study of Lung Cancer 2023 World...
Iruplinalkib Demonstrates Improved Efficacy and Tolerance vs Crizotinib in ALK Inhibitor–Naive, Advanced ALK-Positive NSCLC
The novel ALK tyrosine kinase inhibitor iruplinalkib has demonstrated potential for a difficult-to-treat subset of patients with non–small cell lung cancer (NSCLC), according to data presented at the International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer.1 A...
Expert Point of View: Roy S. Herbst, MD, PhD
Roy S. Herbst, MD, PhD, cautioned that although FLAURA2 is a positive result, most patients will still develop drug resistance. “The result is really good and clearly positive, but if you look at the survival curves, there is still early overlap in a way that makes it unlikely this combination will ...
FLAURA2 Trial: Osimertinib Plus Chemotherapy Improves Outcomes in Advanced EGFR-Positive NSCLC
First-line treatment with osimertinib plus platinum-based chemotherapy achieved a statistically significant and clinically meaningful progression-free survival improvement compared with osimertinib alone in patients with advanced epidermal growth factor receptor (EGFR)-mutated non–small cell lung...
Taiwan National Lung Cancer Early Detection Screening Program Targets Smokers and Nonsmokers With Family History
Findings from the Taiwan National Lung Cancer Early Detection Program have shown that lung cancer screening by low-dose computed tomography (CT) can detect tumors at an early-enough phase to allow for effective intervention. In a recent analysis, 85% of tumors detected by screening were stage 0 or...
Extended Pleurectomy Decortication Plus Chemotherapy for Mesothelioma Linked to Increased Risk of Death in MARS-2 Trial
The results of a recent study from the United Kingdom could spell the end of a long-standing treatment strategy for mesothelioma, according to data presented during the International Association for the Study of Lung Cancer (IASLC) 2023 World Conference on Lung Cancer.1 When combined with...
Highlights From the 2023 World Conference on Lung Cancer
The management of lung cancer and other thoracic malignancies has evolved significantly over the past decade. Thanks to many scientific advancements in the field, new therapeutic options, and improvements in screening and early detection, more patients are being cured, and many others are living...
Small Study Identifies Safe, Effective Radiation Dose to Add to Neoadjuvant Chemotherapy and Durvalumab
Low-dose radiotherapy in combination with the monoclonal antibody durvalumab and chemotherapy as neoadjuvant therapy was well tolerated in patients with potentially resectable stage III non–small cell lung cancer (NSCLC), according to a small study conducted in China and presented at the...
Expert Point of View: Justin F. Gainor, MD
Discussant of the abstract on the ASTRUM-004 trial, Justin F. Gainor, MD, emphasized the significant, positive improvements in survival among patients randomly assigned to receive the PD-1 inhibitor serplulimab vs placebo. Dr. Gainor is Director of the Center for Thoracic Cancers Program, Director ...
ASTRUM-004: Serplulimab Plus Chemotherapy as First-Line Treatment of Advanced Squamous Non–Small Cell Lung Cancer
A novel treatment approach to squamous non–small cell lung cancer (NSCLC) may improve the prognosis for patients with previously limited treatment options, according to data presented at the International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer.1 Findings from ...
Jarushka Naidoo, MHS, MBBCh, on Lung Cancer: Practice-Changing Advances Reported at ESMO 2023
Jarushka Naidoo, MHS, MBBCh, of the Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, discusses some of the key lung cancer data presented at the ESMO Congress 2023: CheckMate 77T, a phase III study of nivolumab, chemotherapy, and surgery for previously untreated resectable stage II–IIIB NSCLC; the ALINA study of alectinib vs chemotherapy in patients with early-stage ALK-positive NSCLC; and overall survival data from KEYNOTE-671, which established the role of chemoimmunotherapy and pembrolizumab. Dr. Naidoo also reviews data in small cell lung and thymic cancers.
Adding Pembrolizumab to Chemotherapy for Previously Untreated Advanced Pleural Mesothelioma
As reported in The Lancet by Chu et al, a phase III trial conducted in Canada, Italy, and France showed that the addition of pembrolizumab to chemotherapy improved survival in previously untreated patients with advanced pleural mesothelioma. Study Details In the multicenter open-label trial, 440...
Perioperative Durvalumab Improves Surgical Outcomes in Resectable NSCLC: Phase III AEGEAN Trial
The addition of durvalumab to neoadjuvant chemotherapy led to higher rates of R0 resections and posed no apparent impediments to successful surgery for resectable non–small cell lung cancer (NSCLC), according to findings from the randomized phase III AEGEAN trial presented at the International...
Benjamin Besse, MD, PhD, on NSCLC: Safety and Efficacy Data on Novel Bispecific Antibody
Benjamin Besse, MD, PhD, of the Gustave Roussy Cancer Centre, discusses new findings on AZD7789, which targets PD-1 and TIM-3, in patients with stage IIIB–IV non–small cell lung cancer (NSCLC) with previous anti–PD-L1 therapy. This bispecific antibody showed manageable safety and preliminary efficacy at tolerable doses (Abstract 1313MO).
