Kartik Konduri, MD, medical director, Chest Cancer Research and Treatment Center, site research leader, chair, Chest Site Tumor Committee, Texas Oncology-Baylor Charles A. Sammons Cancer Center, associate chair, Lung Cancer Research Committee, US Oncology Research, and chair, Lung Cancer Pathways Committee, The US Oncology Network, discusses remaining sequencing challenges in 

-positive non–small cell lung cancer (NSCLC).

targeted therapies, sequencing remains an unmet need in this subgroup of patients with NSCLC, Konduri explains. 

Future research efforts should focus on how certain sequencing strategies could potentially aid in overcoming resistance mechanisms, concludes Konduri.

Videos

Kartik Konduri, MD, discusses remaining sequencing challenges in ALK-positive non–small cell lung cancer.  



Dr. Konduri on Sequencing Challenges in ALK+ NSCLC 

Kartik Konduri, MD, medical director, Chest Cancer Research and Treatment Center, Baylor Charles A. Sammons Cancer Center, Baylor Scott & White Health, discusses the promise of next-generation sequencing (NGS) in patients with non—small cell lung cancer (NSCLC).

 are quite rare in NSCLC, it can be a challenge for physicians to detect these alterations. NGS has emerged as the preferred method of genetic testing in many academic centers because they enable physicians to detect these alterations with one test, Konduri says. When physicians find these genetic abnormalities in patients, they can potentially pair the patient with an effective targeted therapy.

Over the next few years, Konduri predicts that the technology behind NGS will improve. It will become a simple test for physicians to use in the future. However, that doesn’t eliminate the challenge of gathering sufficient tissue samples from patients, notes Konduri. As such, liquid biopsies will have to be further refined in the absence of sufficient tissue samples.

Kartik Konduri, MD, medical director, Chest Cancer Research and Treatment Center, Baylor Charles A. Sammons Cancer Center, Baylor Scott & White Health, discusses the promise of next-generation sequencing testing in patients with non–small cell lung cancer.

Dr. Konduri Discusses Promise of NGS Testing in NSCLC

Kartik Konduri, MD, medical director, Chest Cancer Research and Treatment Center, Baylor Charles A. Sammons Cancer Center, Baylor Scott & White Health, discusses treatment options available for patients with 

-mutant non—small cell lung cancer (NSCLC).

Data are eagerly anticipated from the phase III RELAY trial, in which investigators are examining the combination of erlotinib (Tarceva) and the antiangiogenic agent ramucirumab (Cyramza) in the frontline setting for patients with 

-mutant NSCLC. The trial was initially reported to be positive, but the full data set has yet to be released.

Until those data are released, the standard of care continues to be single-agent osimertinib (Tagrisso). Although data from the phase III FLAURA trial cemented osimertinib as the frontline standard, data from the early-phase AURA trial show additional signals of benefit with the EGFR TKI, both at a dose of 80 mg and 160 mg.

Now, work is being done to overcome resistance to osimertinib, adds Konduri. Many ongoing trials are evaluating the use of specific combinations. There are also trials that are using biomarkers to find a drug that can be paired with osimertinib. If those strategies fail, the combination of chemotherapy and immunotherapy can also be considered.

Kartik Konduri, MD, medical director, Chest Cancer Research and Treatment Center, Baylor Charles A. Sammons Cancer Center, Baylor Scott & White Health, discusses treatment options available for patients with EGFR-mutant non–small cell lung cancer (NSCLC).

Dr. Konduri on Treatment Options for Patients With EGFR-Mutant NSCLC

Kartik Konduri, MD, co-medical director of the Lung Cancer Center of Excellence, Baylor Charles A. Sammons Cancer Center, on the campus of Baylor University Medical Center, discusses sequencing therapy in patients with 

Even though osimertinib (Tagrisso) is established as the frontline standard of care in this space, Konduri says that the older-generation EGFR TKIs still have a role in treatment. The question moving forward is where these drugs will fit in as far as sequencing and in which patients they will benefit. Researchers know that agents like erlotinib (Tarceva) and dacomitinib (Vizimpro) can be more effective than other first- and second-generation EGFR TKIs. Konduri says the field will have to sort out whether patients treated with these drugs will develop a secondary T790M resistance mutation that can allow for osimertinib treatment later on.

Moreover, emerging data appear to be positive with the combination of erlotinib and the antiangiogenic agent ramucirumab (Cyramza) as second-line treatment of these patients. As the data read out, the question of where these treatment strategies fit into the paradigm may be more clear.

Kartik Konduri, MD, co-medical director of the Lung Cancer Center of Excellence, Baylor Charles A. Sammons Cancer Center, on the campus of Baylor University Medical Center, discusses sequencing therapy in patients with EGFR-positive non–small cell lung cancer.

Dr. Konduri on Sequencing Therapy in EGFR+ NSCLC

Kartik Konduri, MD, co-medical director of the Lung Cancer Center of Excellence, Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, discusses lingering questions in patients with non—small cell lung cancer (NSCLC).

Konduri notes that the biomarker space is improving on a day-to-day basis. However, physicians will have to determine how easy it will be to reproduce these biomarkers in regular practice and clinical practice, how efficacious it will be to try to get the testing done, and how much of an expense it will be? These are all practical questions that could have serious implications for patients who will need treatment in the future.

With regard to molecular markers, there are many evaluations that are being done to look for different or resistance mutations. Again, determining how easy it will be to test, and whether physicians adopt liquid-based or tissue-based testing as a means of trying to find these markers are crucial to the progression of treatment for these patients.

Kartik Konduri, MD, co-medical director of the Lung Cancer Center of Excellence, Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, discusses lingering questions in patients with non–small cell lung cancer (NSCLC).

Kartik Konduri, MD

Articles

Dr. Konduri on Sequencing Challenges in ALK+ NSCLC

Dr. Konduri Discusses Promise of NGS Testing in NSCLC

Dr. Konduri on Treatment Options for Patients With EGFR-Mutant NSCLC

Dr. Konduri on Sequencing Therapy in EGFR+ NSCLC

Dr. Konduri Addresses Unanswered Questions in NSCLC