Mark G. Kris, MD


May 23, 2014

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Hello. This is Mark Kris from Memorial Sloan-Kettering Cancer Center, speaking about some of the upcoming abstracts at the 2014 American Society of Clinical Oncology (ASCO®) meeting in Chicago. What has happened in 50 years in the treatment of lung cancers is amazing. Back then, there was no treatment for metastatic lung cancer. At my institution, patients with metastatic lung cancer -- absolutely fit people -- would walk out of work, come here, and would immediately be sent to our phase 1 clinic to take whatever agent we had available for phase 1 testing. Now, that has changed tremendously. We know so much more about the disease and we have so many more treatments. This year at ASCO, we are going to see many very exciting abstracts that will take us to the next level in lung cancer care.

The first group of abstracts is about the agents that specifically target the mutant epidermal growth factor receptor (EGFR) cells, particularly those with the T790M acquired resistance mutation. Until this point, that has been a relatively unmet need, but we are going to see 3 abstracts being presented. AZD9291,[1] CO-1686,[2] and HM61713[3] all appear to have activity and can be given to patients with T790M acquired resistance. In that same session in the clinical science symposium, we will hear a very intriguing abstract[4] about using overall response rate as a surrogate for progression-free survival.

We are going to hear about new agents (such as necitumumab[5]) that appear -- at least in the information released so far -- to have led to survival improvements in advanced lung cancers. This is something that will be used in squamous cell cancers, and we are very anxious to hear about it. We are also going to be hearing a lot more information about agents targeting the T cell. We have already heard about nivolumab, but we will see the data[6] about giving nivolumab with ipilimumab, from a very nice abstract presented previously in melanoma and now in lung cancer as well. We are going to hear about MK-3475 given as initial therapy[7] and as subsequent therapy,[8] and lastly, MEDI4736.[9] These agents will generate a huge amount of discussion and continued excitement about the agents that target the immune system.

Other intriguing abstracts include an interesting study[10] combining bevacizumab with an EGFR-tyrosine kinase inhibitor (TKI) up front in patients with EGFR-mutant lung cancer. We have lacked definitive data for combining anything with an EGFR-TKI showing that it is better than the TKI alone, and this abstract will address that using an agent targeting not the cell cycle but angiogenesis. Another potential game-changer looked at patients with asymptomatic brain metastases and randomly assigned them to receive chemotherapy alone (and treatment of central nervous system metastases if the chemotherapy proves unsuccessful or symptoms intercede) vs chemotherapy plus immediate stereotactic radiosurgery.[11]

I invite you to attend as many lung cancer sessions as possible. I have only mentioned a few of the abstracts; there are many more extremely interesting abstracts. There is a general poster session, a poster discussion session, an oral session, and a clinical science symposium. There are also many interesting lung cancer abstracts in the nonmetastatic setting, as well as small cell mesothelioma and thymoma. We are going to hear for the first time some of the readout from the RADIANT trial,[12] in which erlotinib was given to at least some patients with EGFR mutations in the adjuvant setting. Those data will be out today.

I encourage you to come and listen, and I can assure you that you will leave ASCO with new information and with some ideas that can immediately be used to change the care of your patients and give you a glimpse of what we are going to see in the next year or so in terms of new agents, both targeted and not targeted.


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