Dr. Timothy Burns, of UPMC Hillman Cancer Center, discusses developments in the treatment of lung cancer over the next several years that have exciting potential to impact the field.
The Food and Drug Administration (FDA) in May approved seven therapies to treat patients with non-small cell lung cancer. However, many of the approvals, according to Dr. Timothy Burns, didn’t address areas of need.
In a recent series of interviews with CURE®, Burns, a medical oncologist at UPMC Hillman Cancer Center, discussed how many of the approvals were not considered practice changing, and how patients and oncologists alike can navigate all of the information.
Here, Burns highlights where the real need is in the treatment of lung cancer and what he thinks are some future developments that patients should lookout for.
CURE®: What should patients with NSCLC be on the lookout for? What’s the next big thing coming over the next few years?
Dr. Timothy Burns: I think, hopefully before the next few (years), but maybe in the next year, I think there are novel immunotherapy combinations and even at ASCO, there was some early data; … we've combined ipilimumab, which is a CTL4 inhibitor and nivolumab which is a PD-1 and various combinations depending on the company. But there are several new classes of immunotherapy agents and (other) agents that activate the immune system; they're out there. And I think one of the promising ones that was actually presented at ASCO is a drug that targets something called TIGIT. In that study, (researchers) were looking in the first-line setting, but I think there's a lot of interest in things that target TIGIT as well as another class of drugs that target TIM-3. I think there are some early hints at least in phase 1 and phase 2 trials that there are combinations that may work in patients that become resistant to immunotherapy. I think that's kind of what we're more excited about.
And then on the targeted side; so HER2 is very common in breast cancer, (but) it's also common in lung cancer. But for years we haven't really been able to target it, even with the same drugs we use in breast cancer. So, you can either have a mutation in it, or you can actually have amplification, which is kind of what we see in breast cancer. And there was one drug that was presented at ASCO, which, … generally response rates are like 20 to 30%, had a response rate of greater than 60%. And so, I think we're finally getting drugs that target HER2 in lung cancer.
I think that's exciting. We're making progress, but I think the biggest areas are going to be what comes next after the first-line, you know, as opposed to saying can we; I don't think it's gonna be hard for us to fundamentally move the bar too much in first line. I mean, it's good. A couple years ago that wasn't the case, right? We just had chemotherapy or chemotherapy plus bevacizumab. Things have come a long way.
CURE®: Is there something that I may not have asked or touched upon that you think is important to mention?
To go back to ADUARA, there's two things about ADUARA. ... Osimertinib is going to be a treatment for people in the adjuvant setting and I think that's important to show that a targeted therapy in the adjuvant setting may actually increase your chance of cure. But the other part of that, which I think is key, is that we all do or should be doing molecular testing in our metastatic patients. And you know, that generally involves a next generation panel because there are a number of molecular drivers we're finding. But what ADUARA is going to do is not only get a therapy approved; again, I can't tell you the day or what week but I would say should be shortly, but it is going to institutionalize molecular testing for early stage patients, which we have not done in the past.
Some institutions do it, for example, we do it for all our stage 3 patients because they're at such high risk. There’s essentially a 70% chance that those patients are going to recur, so we'll do the molecular testing of them. But really when this gets approved, it will really make molecular testing essential for all lung cancer patients stage and that will have implications not only for EGFR mutant patients, but we're also going to identify these other drivers and there are already trials underway looking at ALK, which is the most frequent, and others as well and so, we may look back and say, well, this not only got this drug approved for this ... 15 to 20% of patients, but also kind of shifted the way we think about early stage disease and can we target it.