COMMENTARY

Seeking Consensus Amid Abundant New Lung Cancer Data

Mark G. Kris, MD

Disclosures

December 28, 2017

Hello. I'm Mark Kris from Memorial Sloan Kettering, reporting on the recent 12th Annual New York Lung Cancers Symposium held here in New York City on November 11.

We gathered experts and physicians treating lung cancer in the metro New York area, from New Brunswick to New Haven, to review how we care for people and consider new areas of development that affect our field. We discussed advances in targeted therapies, anti-angiogenesis drugs, and spent a lot of time on how these anti-drugs that are immune checkpoint inhibitors are going to be used with radiation and surgery. We talked a lot about how we can get those drugs to the right patient at the right time in their care.

Thoughts on Convergence

The overall theme for this meeting, however, was one that reflects the practice of oncology in general, and if I could use a term for it, it would be "convergence."

We talked about using various modalities and had a specific lecture about the treatment of oligometastatic disease and oligoprogression. Regarding the care of patients with stage IV disease, there was also a lot of talk about how to manage isolated metastases, particularly those in the central nervous system.

These are the issues we face every day. Frankly, they're issues for which there are not a lot of high-level data that people can draw from to uniformly agree on changes [to practice].

Additionally, there was more discussion about the convergence of drugs in systemic therapies within the therapeutic classes. Particularly in the epidermal growth factor receptor (EGFR) space, folks are not just talking about using a drug targeting that receptor, but about a drug targeting resistance pathways. For example, when you have MET amplification after EGFR tyrosine kinase inhibitor resistance, this would mean adding a MET drug. We're also using these second target agents before resistance happens, such as giving a MET drug at the time of disease presentation or a human epidermal growth factor–2 drug to try to prevent resistance at that time.

Another topic is convergence across therapeutic classes. There was a huge amount of discussion about giving chemotherapy with checkpoint inhibitors and also giving other classes of drugs. For example, do you give an anti-angiogenesis drug with an anti-programmed death-ligand–1 drug?

Three Practice-Changing Therapies

The other issue that came up that we're all grappling with is the sheer volume of current information, and the rapid pace at which new information becomes available that changes therapy.

In this area, three things clearly came to mind. First was the very quick development and availability of alectinib as the upfront drug in patients with ALK-positive cancer; second was osimertinib becoming the upfront drug in patients with EGFR mutant lung cancers; and third was the use of durvalumab in patients who had concurrent chemotherapy and radiation as their initial treatment.

There was a general consensus that these three therapies are now our standards. We actually voted on the use of durvalumab using the response technology capability during the meeting, and over 80% of attendees said that the use of durvalumab following concurrent chemotherapy or radiation is something that they are going to add to their treatment plan from today forward.

It's been an unbelievable time. I think everybody who attended was just so excited, from the physician and caregivers being able to do more for our patients, to the patients themselves—having more options not just for a longer life but clearly for a better life. We're all very proud in our community that the way we treat lung cancers is very much the way that other cancers are going to be treated in the years to come. I think we're realizing our challenges and are all working together to try to meet them.

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