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In this video, Drs. Justin F. Gainor, Ibiayi Dagogo-Jack, and Jyoti D. Patel discuss current therapy options for PD-L1–positive non–small cell lung cancer (NSCLC). Dr. Gainor presents the case of a 65-year-old man with 55-year smoking history who was diagnosed with stage II NSCLC. The faculty discuss the importance of molecular testing in patients such as this; molecular testing revealed a PD-L1 tumor proportion score of 25%. They then turn their attention to adjuvant treatment options in light of the recent IMpower010 trial, which found that adjuvant PD-1 pathway inhibition with atezolizumab led to improved disease-free survival among patients with PD-L1 ≥ 1% stage II–III NSCLC. Editor's Note: On October 15, 2021, the U.S. Food and Drug Administration approved atezolizumab for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC with PD-L1 expression on ≥ 1% of tumor cells, as determined by an FDA-approved test.
In this video, Drs. Justin F. Gainor, Ibiayi Dagogo-Jack, and Jyoti D. Patel discuss current treatment options for ALK fusion–positive non–small cell lung cancer (NSCLC). Dr. Gainor presents the case of a 31-year-old patient with minimal tobacco exposure who was diagnosed with metastatic NSCLC. PD-L1 immunohistochemistry revealed a tumor proportion score of 90%, and an EML4-ALK fusion was found on targeted next-generation sequencing. The faculty discuss the importance of testing for oncogenic drivers even in the presence of high PD-L1 expression and review the different generations of ALK inhibitors and their distinguishing features. Finally, they discuss their decision-making processes as it relates to first-line therapy, emphasizing the importance of patient communication, understanding toxicity profiles and resistance, and long-term follow-up.
In this video, Drs. Justin F. Gainor, Ibiayi Dagogo-Jack, and Jyoti D. Patel discuss the management of NTRK fusion–positive non–small cell lung cancer (NSCLC). Dr. Gainor presents the case of a 44-year-old man with a 5 pack-year history of tobacco exposure who was diagnosed with metastatic NSCLC; molecular testing was initially negative, but subsequent targeted next-generation sequencing revealed an NTRK1 fusion, a key oncogenic driver. The faculty discuss when and where to order additional molecular testing or next-generation sequencing in patients such as this. They review recent clinical data surrounding two agents approved by the FDA for NTRK fusion–driven lung cancer, larotrectinib and entrectinib.
In this video, Drs. Justin F. Gainor, Ibiayi Dagogo-Jack, and Jyoti D. Patel discuss the management of RET fusion–positive non–small cell lung cancer (NSCLC). The case presented is a 65-year-old never-smoker patient with metastatic NSCLC who was found to have an EGFR A118V mutation and a KIF5B-RET fusion. The faculty provide background on RET fusions in lung cancer and discuss the different testing modalities used to identify RET alterations. In addition, they discuss how the treatment landscape for these patients has changed in recent years, reviewing data from the recent ARROW and LIBRETTO-001 trials.
In an international, multicenter study, researchers evaluated the impact of prior and concurrent antibiotic exposure in a cohort of patients with advanced non–small cell lung cancer (NSCLC) treated with first-line chemoimmunotherapy combinations. In contrast to what has been reported in patients...
In the Spanish phase III PREMER trial reported in the Journal of Clinical Oncology, Rodríguez de Dios et al found that hippocampal avoidance during prophylactic cranial irradiation (PCI) for small cell lung cancer (SCLC) was associated with better preservation of cognitive function vs PCI alone and ...
In a phase III trial reported in JAMA Oncology, Puneeth Iyengar, MD, PhD, and colleagues found that accelerated hypofractionated image-guided radiotherapy (IGRT) did not improve 1-year overall survival vs conventional radiotherapy in patients with stage II/III non–small cell lung cancer (NSCLC) who ...
Recently, the U.S. Food and Drug Administration (FDA) accepted applications for agents aiming to treat non–small cell lung cancer (NSCLC), differentiated thyroid cancer, renal cell carcinoma (RCC), hypersensitive acute lymphoblastic leukemia (ALL), mucosal melanoma, and endometrial carcinoma....
As reported in the Journal of Clinical Oncology by Keunchil Park, MD, PhD, and colleagues, amivantamab-vmjw given at the selected phase II dose in a phase I trial (CHRYSALIS) produced durable responses in patients with EGFR exon 20 insertion–mutated non–small cell lung cancer (NSCLC) whose disease...
In a study of National Cancer Database data reported in a research letter in JAMA Oncology, Salazar et al found little difference in baseline cancer mortality rates between U.S. states that expanded Medicaid enrollment and nonexpansion states prior to expansion in 2009 and immediately following...
In the phase II NRG-LU001 trial reported in JAMA Oncology, Skinner et al found that the addition of metformin to concurrent chemoradiation did not improve progression-free survival or overall survival at 1 year in patients with unresectable stage III non–small cell lung cancer (NSCLC). Study...
A new population-based study showed that although national lung cancer screening rates decreased in some states, 19 states actually experienced significant improvements in screening rates despite the COVID-19 pandemic. Overall lung cancer screening rates remained low and unchanged, according to...
As reported in JAMA Oncology by Tsakiridis et al, the Canadian phase II OCOG-ALMERA trial, which was closed early due to slow accrual, showed that the addition of metformin to chemoradiation therapy was associated with worse outcomes in patients with unresected locally advanced non–small cell lung ...
On March 3, 2021, lorlatinib was granted regular approval for treatment of patients with metastatic non–small cell lung cancer (NSCLC) with ALK-positive tumors as detected by a U.S. Food and Drug Administration (FDA)-approved test.1,2 The FDA simultaneously approved the Ventana ALK (D5F3) CDx Assay ...
As reported in JAMA Oncology by Scott N. Gettinger, MD, and colleagues, the phase III Lung Cancer Master Protocol S1400I trial showed no improvement in overall survival with the addition of ipilimumab to nivolumab in previously treated, immune checkpoint inhibitor–naive patients with stage IV...
A study published by D. Ross Camidge, MD, PhD, and colleagues in the Journal of Thoracic Oncology has helped to define MET amplification as a rare but potentially actionable driver for non–small cell lung cancer (NSCLC). Dr. Camidge said many of the major developments in the treatment of NSCLC have ...
In a Swiss phase II trial (SAKK 16/14) reported in the Journal of Clinical Oncology, Rothschild et al found that the addition of perioperative durvalumab to neoadjuvant cisplatin/docetaxel resulted in a high major pathologic response rate and an event-free survival rate of 73% in patients with...
As reported in the Journal of Thoracic Oncology by Christian Rolfo, MD, PhD, and colleagues, the International Association for the Study of Lung Cancer (IASLC) has issued a consensus statement on the use of liquid biopsy in advanced non–small cell lung cancer (NSCLC). Select recommendations are...
In a German prospective cross-sectional study reported in JAMA Oncology, Bartels et al found that a high proportion of patients with lung cancer had neuronal antibodies that may be associated with increased risk of cognitive impairment. As stated by the investigators, “Paraneoplastic neurological...
Invited discussant of the BOOSTER trial,1 Edward B. Garon, MD, MS, Professor of Medicine and Director of the Thoracic Oncology Program, David Geffen School of Medicine at the University of California Los Angeles, said the study’s research question is appropriate, since osimertinib was established...
For the second-line treatment of advanced EGFR T790M–mutated non–small cell lung cancer (NSCLC), the performance of osimertinib alone was not found to be different from that of osimertinib plus bevacizumab in the phase II ETOP 10-16 BOOSTER trial, reported at a European Society for Medical...
Invited discussant Nicolas Girard, MD, PhD, of the Curie Institute, Paris, said, “A major challenge in NSCLC is what happens when osimertinib resistance develops.” “A key takeaway point from this study is that the efficacy is driven by resistance mechanism. The overall response rate was 47% in the ...
Combination targeting of epidermal growth factor receptor (EGFR) with amivantamab/lazertinib achieved durable responses in more than one-third of chemotherapy-naive patients with EGFR-mutant non–small cell lung cancer (NSCLC) that had progressed on osimertinib, according to a cohort analysis of the ...
In a study reported in The New England Journal of Medicine, Awad et al identified potential mechanisms of acquired resistance to the KRAS G12C inhibitor adagrasib in patients receiving the agent for treatment of KRAS G12C–mutant cancers. As noted by the investigators, clinical trials of the KRAS...
Despite public smoking cessation initiatives and improved methods for early detection and treatment, lung cancer persists as the leading cause of cancer death in both men and women in the United States. However, over the past decade, smoking cessation efforts, increased screening, and new...
The breakthrough KRAS-specific inhibitor sotorasib achieved responses in patients with KRAS G12C–mutated non–small lung cancer (NSCLC) who had experienced disease progression on platinum-based chemotherapy, immunotherapy, or both treatments. The objective response rate was 37.1%, and responses...
Martin Reck, MD, PhD, of LungenClinic, discusses a 2-year update of the CheckMate 9LA study, which sought to determine whether nivolumab plus ipilimumab combined with two cycles of chemotherapy is more effective than four cycles of chemotherapy alone as a first-line treatment for patients with stage IV non–small cell lung cancer (Abstract 9000).
Non–small cell lung cancer (NSCLC) accounts for 80% to 85% of cases of lung cancer; when it is diagnosed early, there is a 5-year survival rate of 50% to 80%. Black patients have a lower overall incidence of NSCLC than White patients but are more likely to be diagnosed at later stages. They also...
On February 12, 2021, the cyclin-dependent kinase 4/6 (CDK4/6) inhibitor trilaciclib was approved for use to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide–containing regimen or topotecan-containing regimen for...
As reported in The Lancet Oncology by Justin F. Gainor, MD, and colleagues, an interim analysis of the phase I/II ARROW trial has shown that the oral RET inhibitor pralsetinib produced high response rates in previously treated and treatment-naive patients with advanced RET fusion–positive non–small ...
In a retrospective cohort study reported in JAMA Oncology, Erickson et al found that real-world use of targeted therapy after diagnosis of intracranial metastatic disease was associated with improved overall survival vs no use of targeted therapy in patients with HER2-positive breast cancer,...
In an analysis from the global eNRGy1 registry for NRG1 fusion–positive lung cancers reported in the Journal of Clinical Oncology, Alexander Drilon, MD, and colleagues found greater than expected heterogeneity in characteristics of disease. Additionally, patients had poor responses to cytotoxic,...
In recent years, immune checkpoint inhibitors in the treatment of mesothelioma have been a keen area of investigation for this immunogenic solid tumor. With recent publications, principally findings from CheckMate 743 by Baas et al1 (reviewed in this issue of The ASCO Post), combination immune...
As reported in The Lancet by Paul Baas, MD, of The Netherlands Cancer Institute, Amsterdam, and colleagues, a prespecified interim analysis in the phase III CheckMate 743 trial has shown improved overall survival with first-line nivolumab/ipilimumab vs platinum-based chemotherapy in unresectable...
Although once again, the National Comprehensive Cancer Network® (NCCN®) 2021 Annual Conference could not take place on site in Orlando, researchers presented their work virtually in the form of almost 100 posters. The ASCO Post has summarized some that we found particularly interesting. Many...
Atezolizumab given after chemotherapy to patients with resected stage II to IIIA non–small cell lung cancer (NSCLC) significantly improved disease-free survival compared with best supportive care alone in patients whose tumors expressed PD-L1.1 These results of the global phase III IMpower010 trial ...
In a study reported in a research letter in JAMA Oncology, Corbett et al found that the majority of phase III trials investigating systemic therapy in patients with advanced lung cancer, breast cancer, and melanoma over the past 20 years have excluded or restricted enrollment of those with brain...
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 ...
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...
In a retrospective cohort study reported in JAMA Network Open, Heiden et al found that increased time from preoperative diagnostic computed tomography imaging and surgical treatment was associated with an increased risk of disease recurrence and poorer overall survival in patients with clinical...
Vamsidhar Velcheti, MD, of New York University, discusses overall survival and exploratory subgroup analyses from the phase II CodeBreaK 100 trial, which evaluated the use of sotorasib in pretreated KRAS G12C–mutant non–small cell lung cancer (Abstract 9003).
Results from the phase II cohort of the CodeBreaK 100 study showed that treatment with the KRAS G12C inhibitor sotorasib achieved a 37.1% objective response rate and a median overall survival of 12.5 months in previously treated patients with KRAS G12C–mutated non–small cell lung cancer (NSCLC)....
Byoung Chul Cho, MD, PhD, of the Yonsei Cancer Center, discusses study results that showed treatment with the EGFR-MET bispecific antibody amivantamab plus the EGFR inhibitor lazertinib yielded responses in 36% of chemotherapy-naive patients with non–small cell lung cancer whose disease progressed on osimertinib. Genetic biomarkers may be able to identify patients most likely to benefit from the combination regimen (Abstract 9006).
Pasi A. Janne, MD, PhD, of Dana-Farber Cancer Institute, discusses study findings that show patritumab deruxtecan is effective in patients with EGFR-mutated and inhibitor-resistant non–small cell lung cancer. Dr. Janne also explains why targeting HER3, a mutation expressed in most EGFR-altered cancers, is a beneficial treatment approach (Abstract 9007).
Debora S. Bruno, MD, of Seidman Cancer Center at Cleveland Medical Center, discusses study findings that show Black patients with advanced or metastatic non–small cell lung cancer tend to be less likely to undergo biomarker testing or to be treated in clinical trials than White patients. Recommended broad-based testing, says Dr. Bruno, may help ensure equal access to quality care and clinical trials (Abstract 9005).
Over the past 2 decades, the oncologic mantra “early detection leads to cure” has taken on special meaning in lung cancer, persistently a leading cause of cancer death in the United States. “Over a 25-year period, we’ve seen a revolution in early detection, understanding of tumor biology, and...
On May 28, the U.S. Food and Drug Administration (FDA) approved sotorasib (Lumakras) as the first treatment for adult patients with non–small cell lung cancer (NSCLC) whose tumors have a KRAS G12C genetic mutation and who have received at least one prior systemic therapy. This is the first approved ...
In a single-center phase II trial reported in The Lancet Oncology, Nasser K. Altorki, MD, and colleagues found that neoadjuvant durvalumab plus stereotactic body radiotherapy (SBRT) resulted in a markedly higher major pathologic response rate vs durvalumab alone in patients with early-stage...
Adding sintilimab to a regimen of gemcitabine and platinum demonstrated clinical benefit over gemcitabine and platinum alone as first-line therapy in patients with locally advanced or metastatic squamous non–small cell lung cancer (NSCLC). These results from the ORIENT-12 trial were published by...
The EMPOWER-Lung 1 trial, recently reported in The Lancet and reviewed in this issue of The ASCO Post, showed an improvement in progression-free and overall survival with cemiplimab-rwlc in patients with advanced non–small cell lung cancer (NSCLC) and high PD-L1 expression (tumor proportion score...