Leora Horn, MD, MSc, FRCPC, associate professor of cancer research, Vanderbilt Ingram Cancer Center, associate professor of medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, discusses the role of mobocertinib (TAK-788) in patients with non​–small cell lung cancer (NSCLC).

Mobocertinib is an EGFR TKI that is developed for the treatment of patients with 

Notably, minimal data are available with regard to patients with exon 20 insertions because it is a rare mutation that, historically, has not been responsive to first- or second-generation EGFR TKIs, Horn explains.

However, data compiled from Flat​iron Health proved beneficial in terms of comparing the responses of patients with exon 20 mutation​s who received traditional therapies with those ​who received mobocertinib on the phase 1/2 study (NCT02716116), Horn concludes.

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Leora Horn, MD, MSc, FRCPC, discusses the role of mobocertinib in patients with non​–small cell lung cancer.

Dr. Horn on the Role of Mobocertinib in NSCLC 

Leora Horn, MD, MSc, associate professor of cancer research, Vanderbilt University Medical Center, discusses the use of circulating tumor DNA analysis as a means to monitor response to, as well as resistance to, ensartinib in patients with 

—positive non–small cell lung cancer.

The study involved a cohort of patients from the phase II eXalt2 study (NCT01625234) of ensartinib. In 76 enrolled patients, all determined to have ALK-positive disease by fluorescence in situ hybridization, Horn and her colleagues assessed DNA from plasma samples for commonly occurring mutations using a panel of probes developed in collaboration with Resolution Biosciences. A total of 56 patients had genomic alterations detected by next-generation sequencing (NGS), and of those, 80% had 

-positive disease in their tissue samples did not show 

 positivity via NGS, which suggests that NGS may miss some patients who have 

-positive disease, given that 4 of those patients responded to ensartinib. Furthermore, different responses to ensartinib were noted by variant; patients with variant 1 had better response and progression-free survival to ensartinib than did patients with variant 3.  

Leora Horn, MD, MSc, associate professor of cancer research, Vanderbilt University Medical Center, discusses the use of circulating tumor DNA analysis as a means to monitor response to, as well as resistance to, ensartinib in patients with ALK–positive non–small cell lung cancer.

Dr. Horn on Monitoring Response and Resistance to Ensartinib in ALK+ NSCLC

Leora Horn, MD, MSc, clinical director, Thoracic Oncology Program, assistant vice chancellor for faculty development, Vanderbilt-Ingram Cancer Center, provides her thoughts on how agents targeted T790M-mutant non-small cell lung cancer (NSCLC) will be incorporated into NCCN guidelines. Horn delivered a presentation about the management of EGFR-mutation positive metastatic NSCLC at the 2016 NCCN Annual Conference.

In terms of efficacy, all agents for T790M-mutant disease have elicited response rates around 60%, Horn says. Right now, none of these agents are Category 1 because there aren’t data from large, randomized phase III studies yet.

The difference between these agents, she says, lies in the subtleties in toxicities. With rociletinib, some hyperglycemia has been observed while ASP8273 is associated with hypernatremia. Osimertinib (Tagrisso) has caused rash in some patients.

Horn expects all agents to be included in NCCN guidelines if they are approved.

View more from the 2016 NCCN Annual Conference

Leora Horn, MD, MSc, clinical director, Thoracic Oncology Program, assistant vice chancellor for faculty development, Vanderbilt-Ingram Cancer Center, provides her thoughts on how agents targeted T790M-mutant NSCLC will be incorporated into NCCN guidelines.

Leora Horn, MD, MSc

Articles

Dr. Horn on the Role of Mobocertinib in NSCLC

Dr. Horn on Monitoring Response and Resistance to Ensartinib in ALK+ NSCLC

Dr. Horn on Incorporating T790M-Mutant NSCLC Agents Into NCCN Guidelines