Advanced NSCLC: Clinical Challenges for Personalized Treatment
According to the American Cancer Society, there were approximately 221,000 new cases of lung cancer in the U.S. in 2015. These patients accounted for about 13% of all new cancers. Of those, nearly 85-to-90 percent are non-small cell lung cancer (NSCLC).
In this offering from OMedLive, Drs. Panos Fidias and Mark Socinski address some of the challenges, risks, and benefits involved with personalizing treatment of NSCLC. In the first part of this two-part presentation, viewers learn about current treatment options, key therapeutic targets, adverse effects, and limitations for treatment of advanced NSCLC.
The second part discusses the evaluation of the safety and efficacy of emerging novel treatment options and their potential impact for improving outcomes for patients with advanced NSCLC.
NSCLC Treatment Options
Dr. Panos Fidias, Associate Professor of Medicine at the University of Arizona College of Medicine in Phoenix, AZ, shares with us some limitations and challenges of current treatments, including the “efficacy of immunotherapy in genetically defined subgroups.”
In this section, we learn initial trials with our “old friend” Gefitinib versus Placebo showed Gefitinib offered no clear advantage in Overall Survival (OC) over placebo. The Food and Drug Administration (FDA) then pulled Gefitinib from the U.S. market, but it continued to be used extensively in Asia. In this largely homogenous population, Gefitinib was more successful than placebo.
Researchers in the U.S. then ran studies on Caucasian patients in an effort to replicate the Asian successes. In this specific subset, similar results were seen, leading the FDA to re-allow Gefitinib for use in the U.S. When compared with other approved EGFR TKIs (namely Erlotinib and Afatinib), Dr. Fidias shows that Gefitinib has significantly lower toxicity and the two highest side effects are rash (2%) and diarrhea (3%).
Dr. Fidias dives into several comparisons of existing treatment options, paying special attention to adverse events, OS, and Progression Free Survival (PFS).
NSCLC and Immunotherapy
In the second half of the presentation, Dr. Mark Socinski, Professor of Medicine and Cardiothoracic Surgery at the University of Pittsburgh Cancer Institute in Pittsburgh, PA, begins with a “Roadmap of Immunotherapy-Tumor Interactions.” From here, he explains PD-1 receptors versus PD-L1 and -L2, and how different treatment agents perform based on clinical data.
The efficacy of Nivolumab monotherapy by dose in patients with NSCLC is conveyed via a comparison table and is further shown to have relatively low levels of Grade 3-4 adverse events. Comparison is made between Docetaxel’s Objective Response Rate (ORR) and that of Nivolumab, as well as comparisons of OS and PFS by PD-LD1 Expression.
Studies discussed by Dr. Socinski include:
- Phase 1 Trial CA209-003
- CheckMate 017
- CheckMate 057
SQUIRE is the largest randomized Phase 3 trial in the first line treatment for metastatic squamous NSCLC, and the SQUIRE results are “an important advance in the search for a new treatment for patients with metastatic squamous NSCLC, where limited progress has been made over the last two decades.”
For in-depth research and explanation of clinical and trial findings, watch the CME presentation “Clinical Challenges in the Personalized Treatment of Advanced NSCLC” by OMedLive.
Disclaimer: All OMedLive Health articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.
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