David R. Gandara, MD, a professor, director of the Thoracic Oncology Program, and senior advisor to the director of the University of California Davis Comprehensive Cancer Center, discusses how minimal residual disease (MRD) testing might be incorporated into lung cancer clinical practice.

When it comes to technologic advances, including circulating tumor DNA, it is important to consider that there is a period in which the technology is researched before it moves into the standard of care, Gandara says. However, often in oncology, there is a period of time that can range from 1 to several years wherein the novel technology is in a state of transition; it is a period of time in which technologic advances such as an assay, test, or drug is not currently a standard of care, he explains.

MRD is currently in this period of transition and will likely require the results of a large randomized clinical trial such as the phase 3 MERMAID-1 (NCT04385368)—examining durvalumab (Imfinzi)/chemotherapy in fully resected stage II to III NSCLC—and MERMAID-2 (NCT04642469)—examining single-agent durvalumab in stage II or III NSCLC following curative intent therapy—trials, in order to help MRD testing transition to a standard of care.

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David R. Gandara, MD, discusses how minimal residual disease testing might be incorporated into lung cancer clinical practice.


Dr. Gandara on Incorporating MRD Testing into Lung Cancer Practice

David R. Gandara, MD, director, Thoracic Oncology Program, professor, senior advisor to director, UC Davis Comprehensive Cancer Center, treasurer, International Association for the Study of Lung Cancer (IASLC), a 2017 Giant of Cancer Care

 in Lung Cancer, discusses the idea for an online treatment decision tool for lung cancer.

Gandara presented a study noting development and implementation of a web-based educational tool that allows thoracic oncologists to assess the knowledge of new treatments. This would be done around the world and by practitioner. There would be a panel of 5 lung cancer experts who go through nearly 300 scenarios on how a patient might present with advanced non—small cell lung cancer. All the demographics—gender, age, and more&mdash;are available. Patient preferences are also considered, whether it be to live longer or general quality of life. Biomarkers like EGFR and PD-L1 status are also associated with this tool.

A practitioner would enter all this information into the system and await the guidance of the 5-person panel. The oncologist can then compare the decision they would have made on their own with the panel’s expert decision.

David R. Gandara, MD, director, Thoracic Oncology Program, professor, senior advisor to director, UC Davis Comprehensive Cancer Center, treasurer, International Association for the Study of Lung Cancer (IASLC), a 2017 Giant of Cancer Care® in Lung Cancer, discusses the idea for an online treatment decision tool for lung cancer.

David R. Gandara

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Dr. Gandara on Incorporating MRD Testing into Lung Cancer Practice

Dr. Gandara on Online Treatment Decision Tool for Lung Cancer