Shirish M. Gadgeel, MD, MBBS, Mary Lou Kennedy Research Professor in Thoracic Oncology, professor, Department of Internal Medicine, Division of Hematology/Oncology, co-leader, Thoracic Oncology Research Program, and associate director, Networking and Affiliated Centers, University of Michigan Medicine, discusses the utility of liquid biopsies in lung cancer.

A sufficient amount of tumor tissue is needed to perform a tissue biopsy, says Gadgeel. However, tissue biopsies are often performed at the time of diagnosis, leaving an inadequate amount of tissue to biopsy for targeted therapy. Additionally, even if there is enough tissue to sample, patients may have too many comorbidities to safely undergo a tissue biopsy.

Liquid biopsies can be used as an alternative method to provide information on the molecular makeup of the tumor, says Gadgeel. In doing so, the field is able to broaden the utility of molecular profiling and therein the potential therapeutic benefit of targeted treatments.

Videos

Dr. Gadgeel on the Utility of Liquid Biopsies in Lung Cancer

Shirish M. Gadgeel, MD, MBBS, Mary Lou Kennedy Research Professor in Thoracic Oncology, professor, Department of Internal Medicine, Division of Hematology/Oncology, co-leader, Thoracic Oncology Research Program, and associate director, Networking and Affiliated Centers, University of Michigan Medicine, discusses the results of the phase II/III BFAST trial in patients with 

At the 2019 ESMO Congress, Gadgeel presented the results from the 

-positive cohort of the BFAST trial. A total of 2,219 patients were screened; 87 were enrolled into the 

 cohort. The objective of the cohort was to compare the effectiveness of alectinib (Alecensa) in patients with 

-positive disease identified by using blood-based next-generation sequencing (NGS) as opposed to tissue-based NGS.

According to the interim analysis, the investigator-assessed objective response rate with blood-based NGS was 87.4% (95% CI, 78.5%-93.5%), which compared favorably with the ORR observed with tissue-based NGS, which was 82.9% (71.7% confirmed) in the phase III ALEX trial. These data suggest that blood-based sequencing could be as effective as tissue-based sequencing in identifying effective targeted therapy for patients with targetable alterations. Additional cohorts of the trial are using the same design to evaluate targeted therapies based on the identification of 

positivity, and high tumor mutational burden.

Shirish M. Gadgeel, MD, MBBS, Mary Lou Kennedy Research Professor in Thoracic Oncology, professor, Department of Internal Medicine, Division of Hematology/Oncology, co-leader, Thoracic Oncology Research Program, and associate director, Networking and Affiliated Centers, University of Michigan Medicine, discusses the results of the phase II/III BFAST trial in patients with ALK-positive lung cancer.

Dr. Gadgeel on the Results of the BFAST Trial in ALK+ Lung Cancer

Shirish M. Gadgeel, MD, MBBS, professor, University of Michigan Medicine, discusses the updated results of the phase III KEYNOTE-189 trial in metastatic nonsquamous non—small cell lung cancer (NSCLC).

In the KEYNOTE-189 trial, patients were randomized to receive pembrolizumab (Keytruda) and chemotherapy versus chemotherapy alone. The median overall survival rate of patients with pembrolizumab added to chemotherapy was 22 months compared with 10.9 months for patients with chemotherapy alone.

At 2 years, 45.5% of patients who received pembrolizumab were alive compared with 29% of patients who received chemotherapy alone, showing a 16.5% improvement in survival with pembrolizumab. Progression-free survival was 9 months with pembrolizumab compared with 5 months for chemotherapy alone. These improvements were observed across all PD-L1 subsets, including patients whose tumor proportion score was 0. No additional safety signals were identified in this study, according to Gadgeel.

Shirish M. Gadgeel, MD, MBBS, professor, University of Michigan Medicine, discusses the updated results of the phase III KEYNOTE-189 trial in metastatic nonsquamous non-small cell lung cancer (NSCLC).

Shirish M. Gadgeel, MD, MBBS

Articles

Dr. Gadgeel on the Utility of Liquid Biopsies in Lung Cancer

Dr. Gadgeel on the Results of the BFAST Trial in ALK+ Lung Cancer

Dr. Gadgeel on Updated KEYNOTE-189 Data in NSCLC