The Four Studies That Changed Thoracic Oncology in 2017

Mark G. Kris, MD


January 25, 2018

Four Studies That Pushed the Field Forward

Hello. This is Mark Kris from Memorial Sloan Kettering in New York City, speaking about some of the remarkable developments in the field of thoracic oncology in 2017.

In a recent issue of the Journal of Clinical Oncology, there is an update[1] of a previously published trial comparing docetaxel to nivolumab in individuals whose cancers have progressed after initial chemotherapy. I think everyone is familiar with those results. In the update of that study, there is a hidden gem, looking at the progression-free survival (PFS) curves and the actual numbers of patients who are progression-free after 2 years.

I've said it before and will say it again and again: PFS to me is the more important factor in determining a treatment's benefit. Only those patients who remain on that PFS curve can be cured. The longer they are there, the better their quality of life is going to be. Focusing our efforts on PFS is absolutely critical for giving our patients the best and longest lives.

Among patients with squamous cancers in this trial, 15 were on that PFS curve at the end of 2 years versus none with docetaxel. Among patients with adenocarcinomas, 27 were still on that PFS curve versus two in the group that had the docetaxel. That is a very important result and shows us we're moving in the right direction with checkpoint inhibitors and the overall treatment of this illness.

These same kinds of results are reflected in what I'll call the "Big Three" trials published last year: alectinib versus crizotinib,[2] osimertinib versus other tyrosine kinase inhibitors,[3] and durvalumab versus the current standard of no additional therapy in patients with stage III disease who have completed concurrent chemotherapy and radiation.[4] There was virtually a doubling of PFS at 1 year for osimertinib and alectinib, and for the durvalumab trial there's a tripling of the number of people on that PFS curve.

It's a great accomplishment. Clearly, there are not enough people on that curve. We need to find new agents and discover how to best use those we already have to get more people there. But it's a very, very encouraging sign and it's where we want to be.

Focus on PFS in Your Patients

Moving forward, we've been blessed with many additional tools that can lead to improved PFS, which is what we want to give our patients and what they're asking us for. I recommend that you continue to focus on that and to use every tool we have available.

Things have changed tremendously since my training. The very thought that you would resect a deposit in somebody with widespread metastatic disease, and that it could lead to a long-term benefit for that patient, is absolutely radical and would have resulted in an immediate failure by my teachers had I suggested it. Now, however, it's standard of care in the right patient.

I ask you to take this precision medicine initiative to its utmost potential. In every patient, whenever there is a decision-making point, consider every therapy that is available to them. By doing that, you're going to have the best outcomes for patients, which is what they deserve and what we always wanted to do as oncologists.

I hope that the accomplishments we've had in 2017 are going to continue this year; we can do so much more by using the tools we have. I encourage you to focus on PFS; it's our closest surrogate to cure. Every step to get more patients on that curve is one step closer to our ultimate goal of offering a curative treatment to all of our patients with thoracic cancers.

Thank you.


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