Patients with NSCLC Should Not be 'Disheartened' that Many Recent Drug Approvals in the Space Are Not Considered 'Practice Changing'

The Food and Drug Administration in May approved 7 therapies to treat patients with non-small cell lung cancer. And although one expert notes that few are considered “practice changing”, patients should not be disheartened considering there have been so many advancements in the treatment of the disease.
 
BY Ryan McDonald
PUBLISHED July 15, 2020
The Food and Drug Administration (FDA) in May approved seven therapies to treat patients with non-small cell lung cancer (NSCLC). While it’s considered rare for these many approvals in one disease state to happen in a month, it added a flurry of potential treatment options for patients to take advantage of.

As a result, patients may be curious as to how these options fit them and their treatment plan. In a recent interview with CURE®, Dr. Timothy Burns, a medical oncologist at UPMC Hillman Cancer Center, discussed how he would advise patients on all these approvals and what the influx of approvals really means for their treatment. 

CURE: When a patient hears that all these drugs were approved in the NSCLC setting and goes to ask their oncologist what the means for them, what advice would you have for them?

So, we go through the individual cases and we say, ‘it’s unclear if this is any better than the other options that we had before.’ In a patient that wants to avoid chemotherapy, or I don't think can tolerate chemotherapy, (there’s) (Opdivo) and (Yervoy); as well as (Keytruda), and now there's (Tecentriq), so I can kind of say that they seem comparable.

In lack of some improvement on how patients do, either in terms of responding or side effects, it’s not really practice-changing and people will come in with this stuff and you just have to talk to them and say, ‘yeah, it was an interesting trial, but it doesn't look like it's any better than what we had already.’

Can that be somewhat disheartening for a patient to see all these approvals, but as you said, you can't really show that one is better than the other?

It is and it isn't, because I think (with) these combinations, patients are doing pretty well. I mean, with chemo and immunotherapy, the response rates (are) in the 50% range. Patients can have durable responses. I mean, we've had a lot of advances in the last few years. In some cases, these advances really are practice-changing, so I don't think it's disheartening. In the first-line setting, thank god the bar has become a lot higher. You may say, well a 50% response rate; and as I explain to my patients, that means that the tumor shrinks by more than 30%. If you look at the total number of patients where their tumor shrinks or stays the same, it's much higher than that.

So, I explain that to the patient when I talk about what a response rate is, that's something we define in a trial as greater than 30% but the vast majority of patients are having their tumors shrink, at least a little bit, and not grow. You have to explain to the patient that if their tumor is not growing, or if it never grows, they generally would live a normal lifespan. There are some cases where we do need a response, but majority would live a normal lifespan (if the disease stayed the same as it was diagnosed).

In the first-line setting, we've made a lot of progress. In terms of improving the first line, I think it is going to be harder and harder to do unless there’s a targeted therapy. I think where the real need is, and I think where the real excitement is when patients progress on these first-line therapies. But we didn't get any FDA approvals for that, with the exception of (Tabrecta) recently, and I think that’s the real area of need. If you ask the oncologist, where do we need to help our patients, there's small cell, there's after first-line therapy and non-small cell. That's where we're most excited; when these targeted therapies stopped working, then what's next.

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