Vivek Subbiah, MD

Vivek Subbiah, MD, an associate professor, Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, and executive medical director, Department of Medical Oncology Research at the University of Texas MD Anderson Cancer Center, explains what sets medullary thyroid cancer apart from other thyroid cancer histologies.

Over 60% of patients with metastatic MTC harbor the 

 mutations, says Subbiah. In addition, a large proportion of patients also harbor germline 

 mutations. The presence of these germline 

 mutations account for 20% of all cases of MTC.

 mutations lead to more aggressive disease, Subbiah explains. The majority of these patients need to be treated with a RET inhibitor. In contrast, in papillary, anaplastic, and differentiation thyroid cancer, the presence of a 

Videos

Vivek Subbiah, MD, explains what sets medullary thyroid cancer apart from other thyroid cancer histologies.









The Impact of Somatic and Germline RET Mutations in Medullary Thyroid Cancer

Vivek Subbiah, MD, of the Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses how the data from selpercatinib have generated excitement for precision medicine in the treatment landscape for patients with 

The LIBRETTO-001 study demonstrated promising activity with selpercatinib, the selective RET inhibitor, as treatment of patients with 

-mutant non-small cell lung cancer (NSCLC). Subbiah says that this study generated the enthusiasm in precision oncology for 

This opens up new areas of precision oncology, as well as the opportunity for precision medicine in patients with 

Approval of this agent furthers the use of selpercatinib

 in the community setting, Subbiah notes. This now demonstrates proof of principal for selective RET inhibition, so we need to know when patients will receive the most benefit from specific RET targeting, which is upfront, in Subbiah’s personal opinion.

Vivek Subbiah, MD, discusses how the data from selpercatinib have generated excitement for precision medicine in the treatment landscape for patients with RET-driven lung cancer.

Selpercatinib Data Underscore Value of Precision Medicine in RET-Driven Lung Cancer

Vivek Subbiah, MD, of the Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, shares his take home message regarding the treatment of patients with non–small cell lung cancer (NSCLC) who harbor a 

The main challenge lies in identifying patients who harbor a 

 accounts for 1% to 2% of all cases of NSCLC. Testing for this in NSCLC is important now following the 

FDA’s recent approval of selpercatinib (Retevmo) as treatment of patients with lung cancer harboring 

Subbiah’s main message is that NSCLC is the poster child of precision oncology. The more physicians test for, the more we find. In order to win the war against lung cancer, Subbiah says we need to completely understand the disease, and comprehensive next-generation sequencing that includes all fusions and mutations is the first step.

Vivek Subbiah, MD, shares his take home message regarding the treatment of patients with non–small cell lung cancer who harbor a RET fusion.

Genomic Testing Is Necessary in Non-Small Cell Lung Cancer

Vivek Subbiah, MD, of the Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the implications of the phase 1/2 LIBRETTO-001 study, which evaluated selpercatinib (formerly known as LOXO-292; Retevmo) as treatment of patients with 

 fusion-positive non–small cell lung cancer (NSCLC).

Durable efficacy was observed with selpercatinib in patients with 

 fusion-positive NSCLC who had been previously treated with platinum-based chemotherapy, as well as intracranial activity. Fewer than 15% of patients experienced grade 3 or higher adverse events, Subbiah notes.

Interestingly, selpercatinib induced durable efficacy in previously untreated patients as well, Subbiah says. It is estimated that 

 occurs in about 10,000 new cases every year, which makes up about 1% to 2% of lung cancer burden globally. The 

 fusion was only identified in 2012, and the available treatment options were limited to multikinase inhibitors that had some anti-

Selpercatinib gives patients the gift of time, and the antitumor activity in this study was also observed regardless of prior exposure to immune checkpoint inhibitors. The safety profile also suggests that multiple administrations is feasible in most patients. It is critical to identify these patients who are eligible for a RET inhibitor, Subbiah concludes.

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Vivek Subbiah, MD, discusses the implications of the phase 1/2 LIBRETTO-001 study, which evaluated selpercatinib as treatment of patients with RET fusion-positive non–small cell lung cancer.

Selpercatinib Induced Durable Efficacy in RET Fusion-Positive NSCLC

Vivek Subbiah, MD, of the Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the frontline therapeutic options for patients with renal cell carcinoma (RCC).

In the first-line setting for this disease, the agents available in the United States include sunitinib (Suntent), pazopanib (Vortriant), tivozanib (Fotivda), and bevacizumab (Avastin) plus interferon. Tivozanib is also approved in Europe in the first line. Subbiah says that more and more frequently, immunotherapy data has been investigated, such as the checkpoint combination therapy of ipilimumab (Yervoy) and nivolumab (Opdivo).

Over the last 5 years, there has been amazing activity in the immunotherapy space, according to Subbiah. At this point, based on approvals and follow-up data, the checkpoint inhibitor combination of the CTLA4 antibody and PD-1 inhibitor has demonstrated the best data so far in the first line setting for patients with RCC.

Although these regimens are available, not all patients are being cured with these treatments. Most patients have an improvement in progression-free survival, but there is still an unmet need for patients in the second-, third-, and fourth-line setting.

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Vivek Subbiah, MD, discusses the frontline therapeutic options for patients with renal cell carcinoma.

Available Therapies Give Physicians Multiple Options in First Line RCC

Vivek Subbiah, MD, of the Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the potential to combine tivozanib (Fotivda) with other agents, particularly ipilimumab (Yervoy),as treatment of patients with renal cell carcinoma (RCC).

It is challenging to compare a VEGFR tyrosine kinase inhibitor (TKI) with another VEGFR TKI. This can only be performed in a randomized study, says Subbiah. A single-arm study would show responses, but it would be best to perform this type of analysis in a multi-arm randomized clinical trial.

Subbiah says this is also why it is important that all patients with RCC go on clinical trials. By doing so, investigators could get any idea on real-world outcomes with tivozanib or other treatment options in the landscape.

The combination of tivozanib plus ipilimumab is a great idea, says Subbiah, because the VEGFR TKI has a longer half-life. Preclinical data have also shown that the agent is synergistic with checkpoint blockade.

Vivek Subbiah, MD, discusses the potential to combine tivozanib with other agents, particularly ipilimumab, as treatment of patients with renal cell carcinoma.

Vivek Subbiah, MD | Authors

Articles

The Impact of Somatic and Germline RET Mutations in Medullary Thyroid Cancer

Selpercatinib Data Underscore Value of Precision Medicine in RET-Driven Lung Cancer

Genomic Testing Is Necessary in Non-Small Cell Lung Cancer

Selpercatinib Induced Durable Efficacy in RET Fusion-Positive NSCLC

Available Therapies Give Physicians Multiple Options in First Line RCC

Tivozanib Could Be Evaluated in Combination Regimens for Renal Cell Carcinoma