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lung cancer

Second-Line ALK-Positive NSCLC With CNS Progression on First-Line Crizotinib

This is Part 3 of ALK-Positive Metastatic NSCLC: Where Are We Now?, a three-part video roundtable series. Scroll down to watch the other videos from this roundtable.   In this video, Drs. Todd Bauer, Narjust Florez, and Sai-Hong Ignatius Ou discuss the second-line treatment of ALK-positive non–small cell lung cancer (NSCLC) with CNS progression on first-line crizotinib. The patient was initially diagnosed with metastatic EML4::ALK-positive NSCLC at age 40 years in 2013. He did not have any CNS lesions present at the time of diagnosis and started treatment with first-line crizotinib. In February 2014, he developed seizures and was found to have multiple CNS lesions, which were treated with whole-brain irradiation. He subsequently enrolled in the phase I lorlatinib trial in April 2014. In November 2018, while at the 75-mg daily dose, he developed grand mal seizures with no evidence of disease progression, and lorlatinib was held; 11 days later, he returned to his baseline. He resumed treatment with lorlatinib at 50 mg daily and has maintained a near–complete response since that time. In April 2024, he developed recurrent seizures and has been holding lorlatinib since that time with resolution of symptoms.   In the conversation that follows, the faculty discuss the long-term toxicities vs benefit of lorlatinib, the management of toxicities associated with lorlatinib, and the impact of dose reduction on efficacy.

lung cancer

First-Line ALK-Positive NSCLC With CNS Metastases at Baseline and CNS Toxicity

This is Part 2 of ALK-Positive Metastatic NSCLC: Where Are We Now?, a three-part video roundtable series. Scroll down to watch the other videos from this roundtable.   In this video, Drs. Todd Bauer, Narjust Florez, and Sai-Hong Ignatius Ou discuss the first-line management of ALK-positive non–small cell lung cancer (NSCLC) with CNS metastases at basement and CNS toxicity early in treatment. The patient is a 76-year-old prior smoker who presented to the emergency room in February 2024 with complaints of dyspnea. Imaging revealed a 3.2-cm right lower lobe lung mass and a widely metastatic process. Lung biopsy confirmed metastatic NSCLC, and liquid next-generation sequencing (NGS) revealed an EML::ALK variant 3a/b rearrangement. MRI of the brain revealed a 4-mm right frontal lobe metastasis. He started first-line lorlatinib at 100 mg daily in March 2024, and 3.5 weeks later showed decreased conspicuity of the CNS lesion. However, he also began to note mild confusion and “chemo fog” after his second cycle of therapy.   In the conversation that follows, the faculty discuss common toxicities associated with lorlatinib, the role of dose reduction in managing toxicities, and the importance of taking a social history to obtain a holistic understanding of patients.

lung cancer

First-Line ALK-Positive NSCLC With CNS Metastases at Baseline

This is Part 1 of ALK-Positive Metastatic NSCLC: Where Are We Now?, a three-part video roundtable series. Scroll down to watch the other videos from this roundtable.   In this video, Drs. Todd Bauer, Narjust Florez, and Sai-Hong Ignatius Ou discuss the first-line management of metastatic non–small cell lung cancer (NSCLC) with CNS metastases at baseline. The patient presented at age 38 years for evaluation of headaches in 2021. A head CT revealed two lesions with surrounding edema but no midline shift, which was concerning for metastatic disease. A CT of the chest, abdomen, and pelvis revealed a 4-cm left upper lobe lung mass, hilar adenopathy, and a 2-cm liver lesion. Liver biopsy confirmed metastatic NSCLC. While awaiting next-generation sequencing (NGS), she was started on carboplatin plus pemetrexed and was referred for radiation to the CNS lesions. NGS returned with an EML4::ALK variant 1 translocation, and she began treatment with alectinib. One week after alectinib was started, she underwent stereotactic radiosurgery to the CNS lesion.   In the conversation that follows, the faculty discuss the importance of NGS testing for actionable driver mutations regardless of smoking history, appropriate therapy options when starting treatment prior to having NGS results, and the role of stereotactic radiosurgery in the first-line setting.

Lung Cancer

Previously Untreated EGFR-Mutated Advanced NSCLC: Amivantamab/Lazertinib vs Osimertinib

As reported in The New England Journal of Medicine by Byoung Chul Cho, MD, PhD, and colleagues, the phase III MARIPOSA trial has shown improved progression-free survival with amivantamab-vmjw plus lazertinib vs osimertinib in previously untreated patients with EGFR-mutated advanced non–small cell...

Lung Cancer

Second-Line Therapy With Adagrasib in KRAS G12C–Mutated Non–Small Cell Lung Cancer

Second-line therapy with the KRAS inhibitor adagrasib modestly improved progression-free survival and objective response rate over docetaxel in previously treated patients with advanced KRAS G12C–mutated non–small cell lung cancer (NSCLC), according to the primary analysis of the phase III...

Lung Cancer
Palliative Care

Advanced Lung Cancer: Studies Explore Palliative Care Delivered by Telehealth and in a Stepped-Care Approach

Early palliative care can be integrated into the course of treatment for patients with advanced lung cancer via delivery by telehealth with outcomes similar to when palliative care is delivered via in-person visits, according to results of the REACH PC trial presented by Joseph Greer, PhD, of...

Lung Cancer

Durvalumab Consolidation Therapy Extends Survival in Limited-Stage Small Cell Lung Cancer

Consolidation therapy with the PD-L1 antibody durvalumab after chemoradiotherapy extended survival in patients with limited-stage small cell lung cancer (SCLC) compared with standard-of-care chemoradiotherapy alone, according to the first planned interim analysis of the phase III ADRIATIC trial...

Lung Cancer

Adjuvant Use of Alectinib in ALK-Positive NSCLC

On April 18, 2024, the ALK inhibitor alectinib was approved by the U.S. Food and Drug Administration (FDA) for adjuvant treatment after tumor resection in patients with ALK-positive non–small cell lung cancer (NSCLC), as detected by an FDA-approved test.1 Supporting Efficacy Data Approval was based ...

Lung Cancer

Lorlatinib vs Crizotinib in Previously Untreated Advanced ALK-Positive NSCLC

As reported in the Journal of Clinical Oncology by Benjamin J. Solomon, MBBS, PhD, and colleagues, analysis of 5-year outcomes in the phase III CROWN trial showed that median progression-free survival had not been reached in previously untreated patients receiving lorlatinib vs a median of 9.1...

Lung Cancer

Dendritic Cell Therapy in Pleural Mesothelioma

As reported in The Lancet Oncology by Aerts et al, the phase II/III DENIM trial showed no overall survival benefit with a treatment comprising dendritic cells loaded with allogeneic tumor cell lysate (called MesoPher) plus best supportive care vs best supportive care alone as maintenance therapy in ...

Lung Cancer

Previously Treated Metastatic NSCLC: Sacituzumab Govitecan vs Docetaxel

As reported in the Journal of Clinical Oncology by Luis G. Paz-Ares, MD, PhD, and colleagues, the phase III EVOKE-01 trial has shown a numeric but not statistically significant improvement in overall survival with sacituzumab govitecan-hziy vs docetaxel in patients with metastatic non–small cell...

Lung Cancer
Issues in Oncology

Lung Cancer Screening May Improve Early Detection, Survival in U.S. Veterans

Investigators have found that U.S. veterans who underwent lung cancer screening prior to diagnosis were potentially more likely to be diagnosed with earlier-stage disease and have a higher cure rate compared with those who did not undergo screening, according to a recent study published by Edwards...

Lung Cancer

Lung Cancer Screening Prevalence Among Eligible U.S. Individuals

In a study reported in JAMA Internal Medicine, Bandi et al found that only 18% of eligible individuals in the United States were considered up to date—defined as undergoing screening within the past year—for recommended annual lung cancer screening in 2022. As stated by the investigators, “The U.S. ...

Lung Cancer

Tepotinib for Metastatic NSCLC With MET Exon 14–Skipping Alterations

On February 15, 2024, tepotinib (Tepmetko)-—a kinase inhibitor directed against MET, including variants with exon 14 skipping—was granted regular approval for patients with metastatic non–small cell lung cancer (NSCLC) harboring mesenchymal-epithelial transition (MET) exon 14–skipping ...

Lung Cancer

Osimertinib Therapy Poised to Become New Standard of Care for Unresectable Stage III EGFR-Mutated NSCLC

Osimertinib significantly improved progression-free survival compared with placebo in patients with unresectable stage III EGFR-mutated non–small-cell lung cancer (NSCLC) following definitive chemoradiotherapy. These findings of the phase III LAURA trial suggest that osimertinib may become a new...

Lung Cancer
Genomics/Genetics

Study Identifies Subset of Patients With Lung Adenocarcinoma Who Have HER2 Alterations

Researchers have found that about 6% of patients with non–small cell lung cancer (NSCLC) and KRAS, EGFR, or ALK gene mutations may also have HER2 alterations, according to recent findings presented by Dahake et al at the 2024 ASCO Annual Meeting (Abstract 8534).   Background Lung adenocarcinoma is...

Lung Cancer
Palliative Care

New Study Highlights Benefits of Stepped Palliative Care in Advanced Lung Cancer

Researchers have shown the effectiveness of more scalable ways of delivering palliative care in patients with advanced lung cancer, according to new findings published by Temel et al in JAMA and simultaneously presented at the 2024 ASCO Annual Meeting (Abstract 12000). Background More intensive...

Lung Cancer
Issues in Oncology

Stress Related to Residing in Violent Neighborhoods May Be Tied to Aggressive Lung Cancer in Black Men

Exposure to increased neighborhood violence may change the glucocorticoid receptor for the stress hormone cortisol and influence the aggressiveness of lung cancer, according to new findings presented by Heath et al at the Endocrine Society’s Annual Meeting & Exposition 2024. Study Methods and...

lung cancer

Narjust Florez, MD, and Suresh S. Ramalingam, MD, on EGFR-Mutated NSCLC: Update on Osimertinib and Chemoradiotherapy

Narjust Florez, MD, of the Dana-Farber Cancer Institute, and Suresh S. Ramalingam, MD, of Emory University School of Medicine, Winship Cancer Institute, discuss potentially practice-changing phase III results from the LAURA study. This trial showed that osimertinib after definitive chemoradiation therapy improved progression-free survival for patients with unresectable stage III EGFR-mutated non–small cell lung cancer (NSCLC), suggesting this agent may represent a new standard of care in this setting (LBA4).

lung cancer

Minesh P. Mehta, MD, on NSCLC: Tumor Treating Fields for Brain Metastases

Minesh P. Mehta, MD, of Miami Cancer Institute, part of Baptist Health South Florida, discusses results from the METIS (EF-25) trial evaluating the efficacy and safety of tumor treating fields therapy following stereotactic radiosurgery in patients with mutation-negative non–small cell lung cancer (NSCLC) and brain metastases. Tumor treating fields therapy prolongs time to intracranial disease progression and may postpone whole-brain radiation therapy without declines in quality of life and cognition (Abstract 2008).

lung cancer

Narjust Florez, MD, and David R. Spigel, MD, on Limited-Stage Small Cell Lung Cancer: Results From the ADRIATIC Study

Narjust Florez, MD, of Dana-Farber Cancer Institute, and David R. Spigel, MD, of Sarah Cannon Research Institute, discuss phase III findings showing that durvalumab as consolidation treatment after concurrent platinum-based chemoradiotherapy improved survival outcomes compared with placebo in patients with limited-stage small cell lung cancer. According to Dr. Spigel, these data support durvalumab as a new standard of care in this population (Abstract LBA5).

lung cancer

Tony S.K. Mok, MD, on NSCLC: Adagrasib vs Docetaxel in KRAS G12C–Mutated Disease

Tony S.K. Mok, MD, of The Chinese University of Hong Kong, discusses phase III findings from the KRYSTAL-12 study, which showed that adagrasib improved progression-free survival and overall response rate over docetaxel in patients with locally advanced or metastatic non–small cell lung cancer harboring a KRAS G12C mutation who had previously received a platinum-based chemotherapy with anti–PD-(L)1 treatment.

lung cancer

Heather Wakelee, MD, on NSCLC: IMpower010 Survival Results After Long-Term Follow-up of Atezolizumab vs Best Supportive Care

Heather Wakelee, MD, of Stanford University Medical Center, discusses phase III findings showing that the disease-free survival benefit with adjuvant atezolizumab continues to translate into a positive overall survival trend vs best supportive care in patients with stage II–IIIA non–small cell lung cancer (NSCLC). These results further support the use of adjuvant atezolizumab in PD-L1–selected populations, according to Dr. Wakelee (LBA8035).

Lung Cancer

Osimertinib for Patients With Locally Advanced EGFR-Mutated NSCLC: A New Standard of Care?

Osimertinib improved progression-free survival in patients with unresectable stage III EGFR-mutated non–small cell lung cancer (NSCLC) that has been treated with chemoradiotherapy—and may be a new standard of care for this population, according to research presented by Suresh Ramalingam, MD, FACP,...

Lung Cancer

Consolidation Therapy With Durvalumab for Limited-Stage SCLC

Results from an interim analysis of the phase III ADRIATIC study demonstrated that consolidation therapy after chemoradiotherapy with durvalumab extends survival in patients with limited-stage small-cell lung cancer (SCLC) compared to the current standard-of-care treatment of chemoradiotherapy...

Lung Cancer
Palliative Care

Telehealth Shown to Be Effective for Palliative Care Delivery in Patients With Advanced Lung Cancer

New research reinforces the telehealth delivery of palliative care as an effective alternative to in-person visits for patients with advanced lung cancer, providing comparable quality-of-life benefits. This research was presented by Joseph Greer, PhD, and colleagues at the 2024 ASCO Annual Meeting...

lung cancer

Tomasz Jankowski, MD, PhD, on Non–Small Cell Lung Cancer: New Data on a Telomere-Targeting Agent

Tomasz Jankowski, MD, PhD, of Poland’s Medical University in Lublin, discusses a phase II study of THIO, a telomere-targeting agent followed by cemiplimab-rwlc for a difficult-to-treat population of patients with advanced non–small cell lung cancer (Abstract 8601).

Lung Cancer

Lorlatinib vs Crizotinib for Advanced ALK-Positive NSCLC: Extended CROWN Follow-up

The CROWN study (ClinicalTrials.gov identifier NCT03052608) of lorlatinib, a brain-penetrant, third-generation ALK tyrosine kinase inhibitor, vs crizotinib, an inhibitor of receptor tyrosine kinases (including ALK), in the first-line treatment of patients with advanced ALK-positive non–small cell...

Lung Cancer

ASCO Issues Updated Guidelines for Stage IV NSCLC With and Without Driver Alterations

ASCO has issued new evidence-based updates to two living guidelines on the treatment of stage IV NSCLC with and without driver alterations.1,2 Updated Recommendations: Stage IV NSCLC With Driver Alterations The most “extensive work” in the updates occurred in the guideline on stage IV NSCLC with...

Lung Cancer

ALINA Trial: Adjuvant Alectinib Improves Survival vs Platinum-Based Chemotherapy in ALK-Positive NSCLC

As reported in The New England Journal of Medicine by Yi‑Long Wu, MD, of Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, and colleagues, the phase III ALINA trial has shown significantly improved disease-free survival with adjuvant alectinib vs platinum-based chemotherapy...

Lung Cancer

Atezolizumab/Cabozantinib vs Docetaxel in Previously Treated Metastatic NSCLC

As reported in the Journal of Clinical Oncology by Joel Neal, MD, PhD, and colleagues, the phase III CONTACT-01 trial has shown no significant improvement in overall survival with the tyrosine kinase inhibitor atezolizumab (multiple targets, including MET, AXL, VEGFR2, RET, and FLT) plus the...

Lung Cancer

Adding Perioperative Nivolumab to Neoadjuvant Chemotherapy in Resectable NSCLC: CheckMate 77T

As reported in The New England Journal of Medicine by Tina Cascone, MD, PhD, and colleagues, interim analysis in the phase III CheckMate 77T trial has shown that the addition of perioperative nivolumab to neoadjuvant chemotherapy improved event-free survival in patients with resectable non–small...

Lung Cancer

FDA Grants Accelerated Approval to Tarlatamab-dlle for Extensive-Stage SCLC

On May 16, the U.S. Food and Drug Administration (FDA) granted accelerated approval to tarlatamab-dlle (Imdelltra), a bispecific T-cell engager immunotherapy targeting delta-like ligand 3 and CD3, for patients with extensive-stage small cell lung cancer (SCLC) with disease progression on or after...

Lung Cancer

Durvalumab After Chemoradiotherapy in Unresectable NSCLC: Real-World Use and Outcomes

In a U.S. retrospective cohort study (SPOTLIGHT) reported in JAMA Network Open, Mooradian et al found that a substantial proportion of patients with unresectable stage III non–small cell lung cancer (NSCLC) did not receive consolidation durvalumab after chemoradiotherapy—but those who did had...

Lung Cancer

Liposomal Irinotecan vs Topotecan in Relapsed Small Cell Lung Cancer

As reported in the Journal of Clinical Oncology by David R. Spigel, MD, and colleagues, the phase III RESILIENT Part 2 trial has shown no overall survival benefit with second-line liposomal irinotecan vs topotecan in patients with small cell lung cancer whose disease progressed on or after...

Lung Cancer
Issues in Oncology

Smoking Cessation Regimens: Does Dose of Therapy Matter?

Altering or increasing the dosages of smoking cessation regimens may help patients quit smoking, according to a recent study published by Cinciripini et al in JAMA. The findings indicated that the smoking cessation drug varenicline may be more effective than combined nicotine replacement therapy...

Lung Cancer

Glecirasib Shows Efficacy and Safety in KRAS G12C–Mutated NSCLC

Glecirasib monotherapy demonstrated efficacy in previously treated patients with KRAS G12C–mutated non–small cell lung cancer (NSCLC) according to data presented during the ASCO Plenary Series: April 2024 Session (Abstract 468214). Results of the pivotal Chinese phase II study of glecirasib...

lung cancer

Pasi A. Jänne, MD, PhD, on NSCLC, Osimertinib, Chemotherapy: Update From FLAURA2

Pasi A. Jänne, MD, PhD, of Dana-Farber Cancer Institute, discusses an exploratory analysis from the FLAURA2 study, which indicates that baseline levels of plasma EGFR mutation may be prognostic and predictive of clinical benefit with osimertinib plus chemotherapy vs osimertinib alone for patients with non–small cell lung cancer (NSCLC).

Lung Cancer

Neoadjuvant Chemoimmunotherapy in Patients With Early-Stage NSCLC

In a systematic review and meta-analysis reported in JAMA Network Open, Banna et al found that neoadjuvant chemoimmunotherapy was associated with improved event-free survival and pathologic complete response compared with neoadjuvant chemotherapy alone in patients with early-stage non–small cell...

Lung Cancer

Alectinib Approved as Adjuvant Treatment for ALK-Positive Non–Small Cell Lung Cancer

On April 18, the U.S. Food and Drug Administration (FDA) approved the tyrosine kinase inhibitor alectinib (Alecensa) for adjuvant treatment after tumor resection in patients with ALK-positive non–small cell lung cancer (NSCLC), as detected by an FDA-approved test. Alectinib is an orally...

Lung Cancer
Issues in Oncology

Professional Societies Introduce New Evidence-Based Guidelines on Testing Immunotherapy Biomarkers in NSCLC

The College of American Pathologists in collaboration with the International Association for the Study of Lung Cancer, the Pulmonary Pathology Society, the Association for Molecular Pathology, and the LUNGevity Foundation have developed evidence-based recommendations on the use of certain...

Breast Cancer
Colorectal Cancer
Lung Cancer
Issues in Oncology

Survival Rates in Patients With Cancer and Intellectual and Developmental Disabilities

Investigators have found a higher rate of mortality among patients with intellectual and developmental disabilities diagnosed with breast cancer, colorectal cancer, or lung cancer, according to a recent study published by Hansford et al in the Canadian Journal of Public Health. Study Methods and...

Lung Cancer

ALK-Positive NSCLC: Adjuvant Alectinib vs Platinum-Based Chemotherapy

As reported in The New England Journal of Medicine by Yi-Long Wu, MD, and colleagues, the phase III ALINA trial has shown significantly improved disease-free survival with adjuvant alectinib vs platinum-based chemotherapy in patients with resected ALK-positive NSCLC. Study Details In the...

Lung Cancer

Atezolizumab/Cabozantinib vs Docetaxel in Previously Treated Metastatic NSCLC

As reported in the Journal of Clinical Oncology by Joel Neal, MD, PhD, and colleagues, the phase III CONTACT-01 trial has shown no significant improvement in overall survival with atezolizumab plus cabozantinib vs docetaxel after checkpoint inhibitor treatment and chemotherapy in patients with...

Lung Cancer
Issues in Oncology

Radon Gas Exposure May Be Linked to Increased Incidence of Lung Cancer in Nonsmokers

Long-term exposure to radon gas may be associated with a rise in nonsmoking lung cancer cases, according to a recent consumer survey conducted on behalf of The Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC–James)....

Lung Cancer

Lung Cancer Screening Eligibility: Effect of Using History vs Pack-Year History of Smoking

In a study reported in the Journal of Clinical Oncology, Potter et al found that use of a smoking history of ≥ 20 years rather than the current 2021 U.S. Preventive Services Task Force (USPSTF) guideline of ≥ 20 pack-years would increase the eligibility of Black individuals for lung cancer...

lung cancer

Akhil G. Pachimatla, MD, on NSCLC: A Link Between Image-Based Measures of Obesity and Metabolic Pathways

Akhil G. Pachimatla, MD, of Roswell Park Comprehensive Cancer Center, discusses study findings showing that, in patients with non–small cell lung cancer (NSCLC), image-based adiposity measures show stronger correlations with gene-expression changes in these tumors than body mass index measures. Dr. Pachimatla explains the clinical implications (Abstract 37).

Lung Cancer
Issues in Oncology

Study Examines Shared Decision-Making Policies and Practices Around Lung Cancer Screening

A Medicare policy requiring shared decision-making between primary care physicians and patients regarding whether to proceed with lung cancer screening may require further examination, according to a recent study published by Kale et al in the Annals of Family Medicine. The findings indicated that...

Lung Cancer

T-DXd in HER2-Overexpressing Unresectable or Metastatic NSCLC

As reported in The Lancet Oncology by Egbert F. Smit, MD, and colleagues, primary analysis in the HER2-overexpressing unresectable or metastatic non–small cell cancer (NSCLC) cohorts of the phase II DESTINY-Lung01 trial show activity of fam-trastuzumab deruxtecan-nxki (T-DXd) in this setting. Prior ...

Lung Cancer

NSCLC: Neoadjuvant Chemoimmunotherapy vs Neoadjuvant Chemotherapy

In a systematic review and meta-analysis reported in JAMA Oncology, Sorin et al found that neoadjuvant chemoimmunotherapy was associated with better outcomes than neoadjuvant chemotherapy in patients with non–small cell lung cancer (NSCLC). Study Details A search of published studies reported...

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