Expert views on the treatment of advanced NSCLC

Ben Levy, MD: I would like to thank you all for this rich and informative discussion. Before we wrap up, maybe we could get some farewell photos from each of you. Briefly, Misako, what are your final thoughts on our discussion today?

Misako Nagasaka MD, PhD: So many new Agents have come out in the last decade. I am privileged to specialize in lung cancer during this exciting time. As Dr. Dietrich mentioned, the goal will always be to try to achieve better efficacy and better tolerance to ultimately prolong survival without harming the quality of life of our patients, and to select the right patients for the right treatment at the right time is going to be key.

But first, if we can’t identify those targets, we can’t offer them the best effective therapy or clinical trials that might increase their chances of response. Patients, providers, payers, and the wider community need to understand the importance of, and advocate for, large-scale molecular testing so that it can be done efficiently and quickly without causing headaches. heads to patients. I would also like to advocate for clinical trials and be more inclusive in recruiting the diverse patient population we serve. It is the courage of the individual patients who participate in these clinical trials that ultimately drives science forward. I am ready to do everything we can to make clinical trials more accessible to patients. Thank you for hosting me. I really enjoyed the discussion.

Ben Levy, MD: Thank you Misako. Tim, your final thoughts?

Timothy Craig Allen, MD, JD: I’m going to back that up and stack it up a bit. Taking a big step back here, I strongly believe in fairness for all of our patients. We are talking about amazing things here, but I also recognize that there are a large number of lung cancer patients who are not tested or who are tested and the results have not come back in time for therapeutic value. We want to work on this equity. Getting our community patients more involved in trials is an important first step. Academics who work in a molecular tumor consultancy fashion with our colleagues who are on the front line with their patients in community settings can also be valuable.

Interestingly, while we’re talking amazing science here, it often comes down to the logistics of payers, getting the tissues right, or getting the tissues to the right place at the right time, which seems like a big headache. . We will continue to address these challenges in the future, because our patients deserve to have testing and opportunities for these great therapies wherever they are. Thanks again for the invite. It was a delight.

Ben Levy, MD: Thanks Tim. Well said. Martin, what do you think?

Martin Dietrich, MD: I second what has been said. The most important part and the fastest way to improve lung cancer care is to apply what we do. The posts we saw at last year’s ASCO [American Society of Clinical Oncology annual meeting] were very brave to admit that a third of our patients are not receiving appropriate standards of care due to the lack of biomarker testing. This is self-critical data that needed to be made public. We have to do better there.

My main thought, which we haven’t talked about a lot, is that we’re going to enter a multi-dimensional universe of biomarkers for each patient. It won’t be a binary world of EGFR mutant or wild type, but they will be secondary mutations, immunophenotypic markers that complement each other. Understanding them will [become] terribly complex. It will be essential to find ways not only to obtain the test, but also to interpret and apply the test correctly and to use evidence-based algorithms to understand the needs of the patient, sometimes with difficult assessments in more or less new spaces and areas poor in data. It’s going to get more complex, and there’s not going to be an easy answer for that to happen.

Setting up an infrastructure not only to obtain but also to crystallize the data is going to be essential, along with guidance on molecular tumors and industry collaboration. Many commercial vendors have done a wonderful job of making this happen, by accessing this information and submitting it for data. We have an in-house Molecular Tumor Board which is used extensively. These are important things you need if you want to practice good lung cancer care in the future.

Ben Levy, MD: Hatim?

Hatim Husain, MD: What this panel showed me is that there is such a clear focus on molecular strategy in lung cancer. Lung cancer is truly a disease of dysregulated genes. Embracing and understanding this, and getting the proper molecular profiling, is a critical pillar of lung cancer treatment. This is where we are in 2022. We have more genes than we’ve ever had in a targeted frontline lung cancer strategy.

It is important to ensure that patients are properly tested. As we have discussed in this panel, for each of the genes there are many options. The field examines each option for its advantages, disadvantages, effectiveness, brain efficiency in the CNS [central nervous system], and tolerance. A former mentor of mine once told me that medicine is good if we know who to give it to. Lung cancer puts as much emphasis on biomarkers as on our understanding of drugs. We need to improve and disseminate as much information as possible about tissue and fluid analyzes as they parallel drug efficacy.

Ben Levy, MD: Ferdinand?

Fernando C. Santini, MD: If I can add anything after that, I’ll just add another layer of complexity. If we shift everything to early-stage lung cancer, we still have a lot to learn about oncogene-driven treatment in this setting.

Ben Levy, MD: We haven’t even touched on which direction we’re heading in the beginning, given how much data we have in the late stage. Many of you have said it: No. 1, we must remember that it takes a whole village to treat patients. It’s not just the medical oncologist, pathologist, interventional radiologist, interventional pulmonologist, surgeon, and radiation oncologist. It is also the pivot nurse, the nurse practitioner, the palliative care and supportive care team and the social worker. All of these play a key role for our patients. We must remember that it cannot be just one person.

With clinical trials, what Misako said about that matters. We wouldn’t have all of this great data if we didn’t have the clinical trials to produce these drugs and bring them into our clinical practice. It’s a very exciting time. We must remember that clinical trials play a vital role in advancing this field. They become more difficult to do. There is a lot of complexity and coordination, but they have to be done.

Thanks again to our panel. To our audience of viewers, thank you for joining us. We hope you found this Live® Peer exchange useful and valuable discussion for the treatment of your lung cancer patients. Thanks again.

Transcript edited for clarity.

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