A 60-Year Old Man With Untreated Stage IV EGFR-Mutated Non-Small Cell Lung Cancer - Episode 5
Martin Dietrich, MD, PhD:Obviously, nonsmall cell lung cancer has undergone dramatic changes over the last decade-and-a-half since the introduction of targeted therapy. We have a much better understanding of the different biologies. We have a plethora of targeted agents that are available now with an ever-growing arsenal. We do have to pause for a second and look at the lack of efficacy of immunotherapy in the vast majority of patients. There’s a great deal of hype still surrounding immunotherapy, but it’s only a small subset of patientsroughly one-fourth—that is actually benefitting long term. That’s obviously a significant unmet need. Obviously, additional chemotherapy with immunotherapy combinations will be introduced, hopefully later this year.
I think this is going to be a significant opportunity to close that gap between where we’re at and where we want to be. For those patients who do not have molecular alterations, we will be seeing the introduction of MET inhibitors this year, as well as KRAS inhibitors hopefully. And then the question becomes, should we follow a similar concept like we do with chemoimmunotherapy, where we use some of these targeted agents in combination with immunotherapy to not only achieve a targeted response but also a more durable response by the addition of immunotherapy?
There’s still plenty of work to be done. The majority of patients with lung cancer still don’t do well, even though they do significantly better. I think my biggest hope for the near future is that we approximate where we’re at in terms of knowledge with what we’re doing in practice. I think there’s still a significant gap, especially in the testing realm. I think we have to start thinking about our tissue optimization, but in all honesty, after these many years of trying to obtain proper tissue testing in nonsmall cell lung cancer, the introduction of liquid biopsy as a close or even concurrent interventional modality is due.
We have 2 prospective datasets that were reported last year, and both showed thatI’m not advocating that tissue biopsy is inferior—in a real-world setting, liquid biopsy carries tremendous value and should be considered virtually as a side-by-side option to the tissue therapy testing to really match what we know about nonsmall cell lung cancer and what we’re doing for patients in the clinic.
Transcript edited for clarity.
Case: A 60-Year-Old Male with Untreated Stage IVEGFR+NSCLC