Mary Jo J. Fidler, MD, associate professor, Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush Medical College, Rush University Medical Center, discusses the potential utility of circulating tumor DNA (ctDNA) to inform treatment escalation in lung cancer. 

Biomarkers, such as ctDNA, could be utilized to tailor treatment intensification to patients with more aggressive disease, says Fidler. Once-a-day oral TKIs are more convenient for patients compared with oral TKIs plus intravenous antiangiogenic agents or cytotoxic chemotherapy, Fidler explains. 

As such, ctDNA clearance could be used to inform which patients require treatment intensification and which patients can to remain on single-agent TKIs without disease progression, Fidler concludes.

Videos

Mary Jo J. Fidler, MD, discusses the potential utility of circulating tumor DNA to inform treatment escalation in lung cancer.  



Dr. Fidler on the Potential Utility of ctDNA to Inform Treatment Escalation in Lung Cancer 

Mary Jo Fidler, MD, associate professor, medical oncology, hematology, internal medicine, Rush University Medical Center, discusses osimertinib (Tagrisso) in patients with EGFR T790M-positive non—small cell lung cancer.

In a phase III trial, there was a clear benefit of osimertinib when compared with standard frontline platinum doublet chemotherapy in patients who progressed on a first-generation TKI.

Mary Jo Fidler, MD, associate professor, medical oncology, hematology, internal medicine, Rush University Medical Center, discusses osimertinib (Tagrisso) in patients with EGFR T790M-positive non–small cell lung cancer.

Dr. Fidler Discusses Osimertinib in EGFR-Mutated Lung Cancer

Mary Jo Fidler, MD, associate professor, medical oncology, hematology, internal medicine, Rush University Medical Center, discusses how early and persistent oligoclonal T cell expansion correlates with durable response to anti-PD1 therapy in non-small cell lung cancer treatment (NSCLC).

There is a need for other ways to identify patients that will respond to PD-1 inhibitors beside PD-L1 testing. In one recent study, researchers found that both in the tumor cells and the circulating blood, there is an expansion of oligoclonal T cells in patients after they receive anti-PD1 therapy for NSCLC. These T cells were cloned or derived from one or a few cells.

These findings were significant, says Fidler, because in the patients that seem to derive benefit, researchers were able to detect these T cells, which presumably were released by adding the checkpoint inhibitor. However, patients that did not respond to the checkpoint inhibitors did not have the same uptake in these T cells, says Fidler.

Based on these findings, it is possible that oligoclonal T cells could become an alternative method for selecting which patients should continue on with checkpoint inhibitors, and which patients should receive other immunomodulators to try and increase their immune response.

Mary Jo Fidler, MD, associate professor, medical oncology, hematology, internal medicine, Rush University Medical Center, discusses how early and persistent oligoclonal T cell expansion correlates with durable response to anti-PD1 therapy in non-small cell lung cancer treatment (NSCLC).


Mary Jo Fidler, MD

Articles

Dr. Fidler on the Potential Utility of ctDNA to Inform Treatment Escalation in Lung Cancer

Dr. Fidler Discusses Osimertinib in EGFR-Mutated Lung Cancer

Dr. Mary Jo Fidler on the Role of Oligoclonal T Cell Expansion in NSCLC