New Lung Cancer Data: Focus on the Positive

Mark G. Kris, MD


September 18, 2023

This transcript has been edited for clarity.

Hello. It's Mark Kris from Memorial Sloan-Kettering, talking today about the American Society of Clinical Oncology Annual Meeting in Chicago, completed a few months ago. I think it was a great meeting and it reminded us of the importance of meeting colleagues face to face, and the ability to network and to learn in person.

I have to say, I have never had anything approaching the ability to learn and share in person using an online or Zoom meeting. Being together makes a huge difference. I'm just so happy we were able to have that meeting. The tone of the meeting was tremendously upbeat. People felt, particularly in the lung cancer area, that we had many new opportunities for research and new therapies to offer our patients.

I think we were also struck by the difficulties that we face, trying to ensure access to the new therapies for all the patients that could potentially benefit. We heard stories from our European colleagues about how phase 3 trials were completed and regulatory bodies approved an agent for use, but then there was a 1- to 2-year process to get payers to agree to make that drug available to patients. We strive so hard to find these new treatments and get them to patients, and then we have so many stumbling blocks to do that. We just need to find a better way.

I, for one, was overwhelmed by the enormity of the information. It used to be, at least in the lung cancer area, that there was one treatment. Now there are so many treatments and so many nuances. Getting the best information to do that is a formidable task. How to do that is still a work in progress. I think we need to pay attention to how to take what's available, make sure that it gets to the people that can act upon it, and, most importantly, get it to the patients.

I'd also like to comment on some of the thinking in the oncology community. I saw several examples of people focusing on negative data even in an [overall] positive discussion. I'm particularly thinking about a discussion of neoadjuvant therapy where the questioning focused on a small proportion of patients who were offered neoadjuvant therapy but did not ultimately go to surgery.

The medical literature is full of reports about how those patients who did not go to surgery were truly inoperable, they were unresectable, or they had undetected metastases. The problem wasn't neoadjuvant therapy; the problem was, sadly, a patient had a more advanced state of disease or a condition that would make them inoperable.

The other discussion that came up in that neoadjuvant session was about the use of postoperative radiotherapy. There was a clinical trial a few years ago where there was no significant difference in survival based on receiving postoperative therapy or not, and there was some increased toxicity in patients who received therapy postoperatively because of radiation to the heart.

What has been lost is that when you say it was a "negative trial," that means it did not meet its goal of a 12% improvement in 3-year survival, the [prespecified] goal of the trial. Well, the truth is that we've never had that degree of improvement with radiation alone postoperatively. The fact that we didn't reach that goal doesn't say that it can't be helpful for many people.

Also, our radiation therapy techniques, our ability to understand damage to the heart and estimate radiation damage to the heart, which is critical for assessing the toxicity of radiation, have gotten so much better. Treatment plans can now take that into account. Painting with a broad brush and saying that this trial demonstrated that the approach doesn't work really does a disservice to our patients.

I think what we really need to do is dive into the specifics of a patient and ask, do these data truly apply to them? The other thing I was struck by is when we improve our adjuvant and neoadjuvant therapies, more and more people are suffering failure in the chest — lung and lymph node disease. Clearly, ways to improve upon that — and irradiation may be one of them — need to have some attention. Every single randomized trial ever done has shown a clear improvement in control in the chest with postoperative radiotherapy.

ASCO was a great meeting with a large amount of good information. I urge us all to do our homework and look for the new developments that were presented there. If I had a summary statement for the meeting, it is that our job has gotten better. We have better and less toxic treatments to offer to our patients. Our patients have more options open to them and a better chance to keep living their lives.

I have to say, it's much harder for us. We need to learn more. We need to be able to process new data quickly and apply them. We need to make many more decisions along the way for each patient — not only the first chemo but also the second chemo, the third chemo, and when to do consolidation radiation. All of these things that we never had to think about a decade ago, we have to think about now. If we do that, we'll do the best job for our patients.

Mark G. Kris, MD, is chief of the thoracic oncology service and the William and Joy Ruane Chair in Thoracic Oncology at Memorial Sloan Kettering Cancer Center in New York City. His research interests include targeted therapies for lung cancer, multimodality therapy, the development of new anticancer drugs, and symptom management with a focus on preventing emesis.

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