COMMENTARY

Exceeding Our Patients' Expectations Needs to Be the Goal Now

Mark G. Kris, MD

Disclosures

July 23, 2019

This transcript has been edited for clarity.

I'm Mark Kris from Memorial Sloan Kettering Cancer Center.

I have talked about developments in the field of operable, resectable lung cancers and the use of neoadjuvant and adjuvant therapy in more patients. I also have talked about the challenges in developing the best strategies for EGFR-positive lung cancers and about the new agents that we have targeting KRAS, EGFR exon 20, HER3, and MET. This is exciting stuff.

But today I want to highlight two presentations that were made at the American Society of Clinical Oncology (ASCO) meeting this year.

One was by Karen Reckamp[1] from City of Hope Comprehensive Cancer Center in Duarte, California, wherein she discussed MET-targeted therapies, two drugs that appear to have activity and usefulness,[2,3] and acquired and intrinsic resistance.[4] During her presentation, Karen made an important comment about what we need to strive for and what our patients deserve. She talked about the concepts of meeting expectations and of exceeding expectations, and how we need to do the latter in our jobs as oncologists and particularly oncologists in thoracic cancers. Meeting expectations is just not good enough, particularly when all of our patients are facing death from cancer and who can't be cured. We need to exceed expectations in everything we do. Karen's comment reminds us that being equal and being the same is just not good enough. We need to do better. I believe that is very important going forward.

I urge you to think about this whenever you're in a situation saying, "Should we prove that drug X is as good as drug Y?" Or you may be looking at a practicality benefit; for example, you can give a certain drug over 30 minutes instead of 60 minutes. While those considerations can be helpful in certain situations, they don't address the real problem we face: We don't cure enough patients. And cure is what it's all about.

That message was brought home by a presentation by Eddie Garon.[5] Eddie described the long-term survivors who had received pembrolizumab. Now, his point there wasn't that they exist or the percentage of long-term survivors, and it was a good percentage though not the majority of patients. His point was about giving people what they want and what they deserve. And those people who received pembrolizumab had prolonged disease control, no disease progression, and excellent progression-free survival. Those people got the life they wanted, or the life they had back again.

Eddie spoke eloquently about the quality of these folks' lives—not according to some questionnaire but people saying, "Doctor, I am leading the life I led before cancer. I am able to do the things that I aspired to do."

As oncologists, we made that happen because we gave them an effective therapy, and not just an effective therapy that improved things for a short time or lessened the decrement in symptoms. These therapies eradicated the cancer, leading people to become cancer free and, though I hate to use the "C" word, likely cured. That's what we have to strive for. That's what our patients want. I think that's what Eddie said was actually possible with our current generation of checkpoint inhibitors.

We don't cure enough of our patients, but that is the goal. It's progression-free survival. It's a life free of cancer. Cancer equals a shortening of life; cancer equals a degradation of the decency of patients' lives; cancer equals people not being able to live the lives they choose. Our job is to keep cancer away. Progression-free survival gives people the lives they want and deserve. Eddie eloquently spoke about how he could deliver that to those people who had these extended responses after receiving pembrolizumab. I believe that's a good example of what we all need to strive for.

Going forward, we need to look for those therapies that can give back people's lives. We have to work harder to help more patients have the same kind of benefit as those who responded to pembrolizumab.

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