Learning to Tailor Targeted and Immune Therapy in Lung Cancer

Welcome to OncLive On Air^™! I’m your host today, Jessica Hergert.

OncLive On Air^™ is a podcast from OncLive^®, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, OncLive covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.

In today’s episode, we had the pleasure of speaking with the faculty of the MedStar Georgetown University Hospital-sponsored Institutional Perspectives in Cancer webinar on lung cancer.

At the meeting, faculty spotlighted key advances made with targeted therapies in lung cancer, the ways in which immunotherapy has complicated treatment decisions, the optimization of TKIs across the continuum of care in EGFR-mutant lung cancer, and the sequencing and resistance questions that have emerged following the expansion of the ROS1-directed armamentarium.

First, we spoke with co-chair of the meeting, Benjamin Levy, MD, associate professor of oncology and clinical director of medical oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. The most promising agents in lung cancer are osimertinib (Tagrisso), fam-trastuzumab deruxtecan-nxki (Enhertu), and mobocertinib (TAK-788), according to Levy. Listen on to hear Levy expand on the ever-changing lung cancer treatment paradigm and advances that have recently been made with targeted therapies.

Next, Joshua Reuss, MD, a thoracic medical oncologist at MedStar Georgetown University Hospital and an assistant professor in the Department of Medicine at Georgetown University Medical Center, stopped by. Whether to recommend single-agent immunotherapy, dual immunotherapy, or combination chemotherapy has become the focus of frontline treatment discussions in advanced non–small cell lung cancer (NSCLC), explained Reuss, who added that PD-L1 status, the longevity of the data, and durability of benefit are among the primary elements of treatment selection. Listen on to hear Reuss discuss the lung cancer armamentarium, the role of immunotherapy combinations, and the significance of biomarkers.

Following the establishment of the third-generation TKI osimertinib as a standard-of-care treatment in patients with EGFR-mutated NSCLC, research efforts have centered on how to build on the success achieved with this approach, how to overcome resistance to the agent, and how to individualize care decisions with TKIs to optimize outcomes, said Kristen A. Marrone, MD, a thoracic medical oncology specialist and associate program director of the Hematology/Medical Oncology Fellowship Program at the Johns Hopkins University School of Medicine. Listen on to hear Marrone speak about research efforts with osimertinib in EGFR-mutated lung cancer, overcoming resistance to the agent, and optimizing sequential molecular testing.

We were then joined by Ibiayi Dagogo-Jack, MD, an instructor of medicine at Harvard Medical School and a thoracic oncologist in the Department of Internal Medicine/Medical Oncology at Massachusetts General Hospital. Investigational agents, such as lorlatinib (Lorbrena) and

repotrectinib (TPX-0005), are poised to further expand the armamentarium beyond the well-founded use of crizotinib (Xalkori) and entrectinib (Rozlytrek) in ROS1-rearranged NSCLC, said Jack. Listen on to hear Dagogo-Jack discuss the nuances of navigating the treatment landscape of ROS1-rearranged NSCLC and encouraging agents in the pipeline.

We closed out the night with Stephen Liu, MD, co-chair of the meeting, and associate professor of medicine, Division of Hematology and Oncology, Georgetown University Medical Center, who stated that EGFR, ALK, and ROS1 abnormalities are no longer the only oncogenic drivers worthy of discussion in NSCLC, adding that the field has seen an abundance of highly selective RET, MET, HER2, and KRAS inhibitors that have the potential to deliver durable responses. Listen on to hear Liu discuss some pivotal data that support the expanding reach of targeted therapy in NSCLC.