LUNG CANCER

Multiple presentations at the 2019 ESMO Congress add to the evidence that blood-based biomarkers have predictive utility in advanced non-small cell lung cancer. Blood-based next-generation sequencing has also shown clinical utility in aiding treatment decisions for physicians treating this disease.

Following the 2019 ESMO Congress, experts across various fields highlighted some next steps and how these treatment options will improve the treatment landscape for patients with ovarian, lung, breast, GI, or GU cancers. Overall, the abstracts presented at this year’s meeting will change the treatment paradigm in a number of patient populations.

The introduction of<strong> </strong>CDK4/6 inhibitors for the treatment of hormone receptor&ndash;positive, HER2-negative breast cancer has transformed therapy management and extended survival for this patient population. The next step in the process of tailoring therapy towards individual patients is the introduction of targeted therapies for patient subsets with driver aberrations.

The multikinase inhibitor entrectinib induced frequent and durable responses, which often deepened over time, in patients with <em>ROS1</em>-positive and&nbsp;<em>NTRK</em>-positive non&ndash;small cell lung cancer, according to an integrated analysis of 3 clinical trials.

The addition of direct oral oral anticoagulants for the management of venous thromboembolism in patients with cancer is the latest change to previous guidelines issued by the American Society of Clinical Oncology.

In the phase III CASPIAN study, durvalumab added to etoposide and platinum-based chemotherapy delayed the development of new lesions and improved patient-reported outcomes compared to etoposide and platinum-based therapy alone in untreated patients with extensive-stage small cell lung cancer.

Using a measure known as the growth modulation index, patients with TRK fusion&ndash;positive cancers who were treated with larotrectinib had a clinically meaningful improvement in progression-free survival compared with the time to progression on their prior treatment, an analysis of patients enrolled in 1 of 3 clinical trials has found.

Adding PARP or CHK1 inhibitors to immunotherapies for the treatment of small cell lung cancer is the next step in the pipeline of novel combination approaches, according to Charles M. Rudin, MD, PhD, in a presentation at the <em>20th Annual </em>International Lung Cancer Congress.

Investigators have identified tumor mutational burden as a promising biomarker for predicting immunotherapy responses in patients with advanced stages of non&ndash;small cell lung cancer, but is it ready for clinical application?

Paul A. Bunn, Jr., MD, discusses subsets of patients with lung cancer that can benefit more from enrolling on clinical trials with immunotherapy compared with patients who do not benefit as much from immunotherapeutic approaches. Immunotherapy does not work in every patient, Bunn notes.

Progression-free survival was not improved with pembrolizumab over chemotherapy in patients with&nbsp;malignant pleural mesothelioma, missing the primary endpoint of the phase III European Thoracic Oncology Platform PROMISE-meso trial presented at the 2019 ESMO Congress.

Three clinical trials presented at the 2019 ESMO Congress show that the tropomyosin receptor kinase&nbsp;inhibitor larotrectinib continues to show anti-tumor activity, including long-lasting objective responses and low toxicity, according to results from an integrated analysis.

Frontline atezolizumab plus&nbsp;carboplatin plus etoposide has shown an improvement in overall survival over&nbsp;placebo plus CP/ET in&nbsp;the treatment of patients with extensive-stage small cell lung cancer, according to updated results from the phase III IMpower133 trial.

Median overall survival was improved by 6.8 months with osimertinib as a first-line treatment for patients with&nbsp;metastatic, <em>EGFR</em>-mutant non&ndash;small cell lung cancer compared with erlotinib or gefitinib, despite crossover between arms, according to updated data from the phase III FLAURA study presented at the 2019 ESMO Congress.

A final analysis of part 1 of the phase III CheckMate 227 trial showed that nivolumab plus ipilimumab led to survival benefits in previously untreated patients with advanced non&ndash;small cell lung cancer, regardless of PD-L1 expression status.

Single-agent atezolizumab improved overall survival in newly diagnosed patients with&nbsp;wild-type non&ndash;small cell lung cancer who had &ge;50% expression of PD-L1 on tumor cells or &ge;10% expression on tumor-infiltrating immune cells compared with platinum-based chemotherapy, according to the interim survival analysis of the phase III IMpower110 study.

In an interview with&nbsp;Targeted Oncology, Tetsuya Mitsudomi, MD, summarized the major areas under investigation for the treatment of patients with lung cancer and highlighted key findings from the updated 5-year data of the KEYNOTE-001 trial.

In an interview with <em>Targeted Oncology</em>, Dean A. Fennell, MD, PhD, explained the need for the MIST trial and personalized treatment for patients with mesothelioma.

In his presentation on translational research in non&ndash;small cell lung cancer during the <em>20th Annual </em>International Lung Cancer Congress&reg;, Scagliotti, a professor of oncology at the University of Torino in Italy, discussed the promising evolution of therapeutic options, pointing to steps being taken to create a larger precision medicine ecosystem.&nbsp;

Based on findings from retrospective analyses and clinical trial data, patients with <em>ALK</em>-rearranged non&ndash;small cell lung cancer may be able to receive sequential ALK inhibitors following progression with similar second and third-generation agents.

Patients with non&ndash;small cell lung cancer on radiotherapy had a worse overall survival when a hurricane disaster was declared for their hospital than patients who did not experience a declaration, according to a study published in<em> JAMA</em>.

A matched retrospective comparison showed that progression-free survival&nbsp; in patients with advanced non-small cell lung cancer and actionable mutations was similar whether treatment went was guided with the use of tissue or circulating tumor DNA analysis with the Guardant360 assay.