COMMENTARY

What's New for Lung Cancer? Stay Tuned for ASCO 2017

Mark G. Kris, MD

Disclosures

May 15, 2017

Hello. This is Mark Kris, from Memorial Sloan Kettering.

The American Society of Clinical Oncology (ASCO) released the titles of the abstracts that are going to be presented at the 2017 annual meeting in Chicago in early June. These titles give us a good glimpse of where we are in the field of thoracic medical oncology and thoracic oncology. We can tell what various topics are going to be discussed, trends, and what questions people have.

I think to the surprise of no one, the number 1 topic again is the emergence of checkpoint inhibitors, specifically atezolizumab,[1,2] nivolumab,[3,4,5] and pembrolizumab.[6,7] There is little doubt that the field has changed radically since these drugs became available. [These medications are] considered for every patient at some point in their care. For squamous and adenocarcinomas, it is at the beginning of care.[8] For small cell lung cancer, I think the standard now is second-line treatment.

We have many questions. How can we predict which patients will benefit from these agents? What do we do when these drugs stop working or do not work in the first place? What is the next step within the field of immunotherapy for the patients that do not benefit or stop benefitting from these drugs? All of these things are going to be discussed at the 2017 ASCO meeting.[9,10]

The number 2 topic is EGFR, primarily treatment of EGFR acquired resistance with the use of osimertinib.[11] It is clearly a very useful drug, and it is available. In the presentations, so far there is no abstract discussing its use as an initial therapy, and we really look forward to that.

We are also very anxious to see the results of the trial of postoperative adjuvant gefitinib vs chemotherapy.[12]

A trial[13] is going to be presented this year that may be one of the first trials where a tyrosine kinase inhibitor (TKI) was given to a defined cohort of patients with epidermal growth factor receptor (EGFR) mutant lung cancers, and we will get some idea of the head-to-head comparison between those drugs and chemotherapy. I am not a fan of this kind of trial design. Chemotherapy is a curative therapy in patients with locally advanced disease, and we need to give that first and see whether the TKI can add to it. But these are the data we have, and it is important to get that out.

There is some discussion about new drugs in the ALK space, specifically lorlatinib.[13]

There are a number of trials using cytotoxic agents, conventional ones, also antiangiogenesis drugs, and I think that it is important that we have discussions[14] of those agents. For better or worse, they remain the mainstay of care for patients with thoracic cancers—standard chemotherapies are the treatments most commonly given.

There are trials with radiation, particularly a trial[15] using prophylactic cranial radiation for patients with locally advanced non-small cell lung cancers that have been completely resected and treated definitively. Brain relapse is a huge problem for these patients, and needs to be addressed. An idea is to use prophylactic whole-brain radiotherapy. There is fairly compelling evidence in the nonrandomized data that it can make a difference. Unfortunately, no definitive trial has ever been mounted to prove that or sort out adverse effects of whole-brain radiotherapy. Is it worth the benefit that it can give these patients? This trial will give us some information along those lines.

In the clinical science symposium this year, there is discussion about two newer targets: HER2 [16,17,18] and MET exon 14.[19,20,21] I have been part of the research in both of these areas, and what is nice about these two targets is that agents are already on the scene.

Being presented at ASCO this year is the use of ado-trastuzumab emtansine in patients with HER2-mutant and HER2-overexpressing lung cancers,[16,17] and with available drugs to treat the MET mutations, particularly crizotinib and other agents that target MET. It is great to find targets, it opens up new options for patients, and it is even better when we have drugs available today for those targets.

Stay tuned for more information as ASCO rolls it out. Just about all abstracts will be released in mid-May, and the final release will occur at the time of the meeting. There is going to be a lot of great information to discuss this year, and I encourage those of you who work in the lung cancer field to pay attention to these new developments. I am sure you will find something that is going to help your patients right away. Thank you.

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