Expert Discusses Targetable Mutations and New Agents in Lung Cancer

New advancements are quickly advancing the treatment landscape of lung cancer.
BY GINA COLUMBUS @ginacolumbusonc
With the influx of FDA approvals of targeted agents and immunotherapy, lung cancer treatment is drastically different than it was years ago. Advances are also being made in the diagnostic arena as well, as more targetable mutations have been identified through plasma-based assays.

Most recently, in October 2016, the FDA approved the PD-1 inhibitor Keytruda (pembrolizumab) for the frontline treatment of patients with metastatic non–small cell lung cancer whose tumors have at least 50 percent PD-L1 expression and who do not harbor EGFR or ALK aberrations. This was an update from Keytruda’s initial approval in the second-line setting in October 2015.

Keytruda is joined by two other FDA-approved checkpoint inhibitors Opdivo (nivolumab) and Tecentriq (atezolizumab).

Numerous targeted agents have also been approved aimed at patients with EGFR and ALK mutations or abnormalities. For patients with EGFR-mutant tumors, Gilotrif (afatinib), Tarceva (erlotinib) and Iressa (gefitinib) are on hand, along with Tagrisso (osimertinib), a drug able to target the resistance mutation T790M. With ALK-positive patients, Xalkori (crizotinib), Zykadia (ceritinib) and Alecensa (alectinib) have been approved as targeted therapies, too.

These are just a handful of the advancements highlighted by Mark G. Kris, M.D.

In an interview with CURE, Kris, a medical oncologist at Memorial Sloan Kettering Cancer Center, shares his thoughts on the prominent advancements in the field of lung cancer, how liquid biopsies are shaping treatment decisions, and his predictions for the years ahead.

What are these advancements that have shaped therapy?

First, we have an evolution in how the targets [for targeted therapies] are found. There is more comprehensive mutational tissue testing and more available tissue testing. Now, in addition to tissue, you have the ability to detect these relevant mutations in blood—both individual ones like T790M or EGFR in next-generation sequencing (NGS) panels of mutations where you can assay what options are available for individual patients. That is something that is rapidly becoming a standard of care here in the United States.

More information is available, as well, about new drugs, such as Tagrisso at time of acquired resistance and also as initial therapy. Xalkori is here with its use in MET exon 14 skipping mutation, and with Cabomeytx (cabozantinib) and its use in RET—all these topics are being discussed. Now, the great opportunity that we have with these multiple agents is how do we select which one to give first, and how do we decide which one to give second? What information is there to make these choices?

Talk about this article with other patients, caregivers, and advocates in the Lung Cancer CURE discussion group.
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