Jyoti Malhotra, MD, MPH, interim director, Phase I and Investigational Therapeutics Program and medical oncologist, Rutgers Cancer Institute of New Jersey, associate professor of medicine, Rutgers Robert Wood Johnson Medical School, attending physician at Robert Wood Johnson University Hospital, discusses challenges with precision medicine in advanced solid tumors.

Currently, a main challenge in this patient population is making testing more widely available to patients, Malhotra says. However, additional FDA approvals are increasing accessibility to molecular testing, Malhotra explains. However, additional efforts are needed to ensure every patient with advanced solid tumors is tested for a potentially actionable target, Malhotra adds.

Another challenge is making clinical trials more accessible to patients because currently, trials are accessible only at select sites, Malhotra continues. However, clinical trials need to be taken into the community setting to make these targeted therapies more accessible, as not all patients are able to travel to a testing site, Malhotra concludes.

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Jyoti Malhotra, MD, MPH, discusses challenges with precision medicine in advanced solid tumors.


Dr. Malhotra on Challenges with Precision Medicine in Advanced Solid Tumors

Jyoti Malhotra, MD, MPH, medical oncologist, Rutgers Cancer Institute of New Jersey, assistant professor of medicine, Robert Wood Johnson Medical School, discusses the rationale to evaluate racial disparities in lung cancer survivors.

Racial disparities exist throughout the treatment of patients with lung cancer, Malhotra says. These disparities are present in the setting of follow-up care and surveillance, which is a critical part of lung cancer survivorship, Malhotra explains. Follow-up care allows survivors to receive disease-related symptom management and routine screening for early detection of recurrence, Malhotra adds. 

, findings from a cross-sectional study of racial differences in follow-up care of lung cancer survivors through New Jersey’s statewide cancer registry were presented in a virtual poster. The results showed that more non-Hispanic White survivors received a surveillance scan within 1 year compared with non-Hispanic Black survivors (

Jyoti Malhotra, MD, MPH, discusses the rationale to evaluate racial disparities in lung cancer survivors.  



Dr. Malhotra on the Rationale to Evaluate Racial Disparities in Lung Cancer Survivors 

Jyoti Malhotra, MD, MPH, medical oncologist, Rutgers Cancer Institute of New Jersey, assistant professor of medicine, Robert Wood Johnson Medical School, discusses the safety profile of plinabulin in combination with nivolumab (Opdivo) and ipilimumab (Yervoy) in relapsed/refractory small cell lung cancer (SCLC).

The results of a phase 1 study (NCT03575793), which were presented during the 2021 ASCO Annual Meeting, demonstrated that the combination of plinabulin, nivolumab, and ipilimumab was safe and well tolerated among 16 patients with extensive-stage SCLC who had progressed on or after prior platinum-based chemotherapy.

The maximum tolerated dose of plinabulin was 30 mg/m

, says Malhotra. Regarding safety, 50% of patients experienced at least 1 grade 3 or higher treatment-related adverse effect (TRAE). The most common TRAEs were nausea, infusion-related reactions, vomiting, diarrhea, and fatigue. 

Immune-related AEs (irAEs) were rare; 1 patient each had grade 3 or higher colitis, transaminitis, and elevated lipase, Malhotra explains. Notably, these AEs were resolved with steroids, Malhotra adds. It is hypothesized that because plinabulin inhibits phosphodiesterase-4, it can mitigate some of the irAEs associated with checkpoint inhibitors, concludes Malhotra.

Jyoti Malhotra, MD, MPH, discusses the safety profile of plinabulin in combination with nivolumab and ipilimumab in relapsed/refractory small cell lung cancer.



Dr. Malhotra on the Safety Profile of Plinabulin/Nivolumab/Ipilimumab in Relapsed SCLC 

Jyoti Malhotra, MD, MPH, medical oncologist, Rutgers Cancer Institute of New Jersey, and assistant professor of medicine, Robert Wood Johnson Medical School, Rutgers University, discusses a phase I multicenter trial of PD-1 blockade with pembrolizumab (Keytruda) with concurrent chemoradiation in patients with locally advanced, unresectable non—small cell lung cancer (NSCLC).

The treatment landscape for stage III lung cancer has changed significantly because now when patients are treated with chemoradiotherapy, they are also treated with consolidation therapy with durvalumab (Imfinzi) for up to 1 year, Malhotra explained. This phase I study, which was presented at the 2019 ASCO Annual Meeting, is looking to improve outcomes for patients with NSCLC by optimizing the combination of radiation and immunotherapy, according to Malhotra.

In this trial, there were 6 different cohorts. The first 2 cohorts received immunotherapy after completion of chemoradiation. In the last cohort, on the other hand, patients were given immunotherapy and chemoradiation concurrently.

The combination does not have any limiting toxicities, which was defined as grade 4 pneumonitis. The combination seems to have clinical activity, with a progression-free survival is 20.3 months, which is significantly longer than historical outcomes, according to Malhotra.

Jyoti Malhotra, MD, MPH, discusses a phase I multicenter trial of PD-1 blockade with pembrolizumab with concurrent chemoradiation in patients with locally advanced, unresectable non–small cell lung cancer.

Jyoti Malhotra, MD, MPH

Articles

Dr. Malhotra on Challenges with Precision Medicine in Advanced Solid Tumors

Dr. Malhotra on the Rationale to Evaluate Racial Disparities in Lung Cancer Survivors

Dr. Malhotra on the Safety Profile of Plinabulin/Nivolumab/Ipilimumab in Relapsed SCLC

Dr. Malhotra on Pembrolizumab During Concurrent Chemoradiation in NSCLC