Biomarker-Driven Lung Cancer

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Precision medicine has produced some dramatic successes in patients with advanced cancer. With developments in molecular profiling, targeted therapies are being applied to multiple tumors, most notably in advanced melanoma, NSCLC, and several types of leukemia. Alison Schram, MD, and David M. Hyman, MD, point out the challenges in determining the proportion of patients who will benefit from receiving targeted therapies.

Acquired resistance to tyrosine kinase inhibitors targeting <em>EGFR</em> mutations in patients with non&ndash;small cell lung cancer are leading to next-generation therapies equipped to circumvent the mutations that arise from initial treatment.&nbsp;A review of these mechanisms, and the latest agents being developed to address them, shows that the pipeline holds promise for the future.

The phase III TAHOE trial evaluating rovalpituzumab tesirine as a second-line treatment for&nbsp;patients with advanced small cell lung cancer has been put on hold, based on a recommendation from an&nbsp;Independent Data Monitoring Committee, according to AbbVie, the developer of the investigational antibody-drug conjugate.<br /> &nbsp;

Atezolizumab (Tecentriq) has been approved by the FDA&nbsp;for use in combination with bevacizumab, carboplatin, and paclitaxel as a first-line treatment for patients with metastatic nonsquamous non-small cell lung cancer. This indication excludes patients with <em>EGFR</em>/<em>ALK</em> aberrations.

Using durvalumab&nbsp;(Imfinzi) combined with&nbsp;tremelimumab for the frontline treatment of patients with metastatic non&ndash;small cell lung cancer did not result in a&nbsp;statistically significant improvement in overall survival compared to standard chemotherapy, according to a press release from AstraZeneca.

Emerging Biomarkers in NSCLC

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Alexander E. Drilon, MD, discusses&nbsp;developing markers in the non&ndash;small cell lung cancer paradigm.

Groundbreaking developments in cancer therapies can change lives, extending survival and sending patients who previously thought their chances were slim into remission. But these therapies come at a cost, and many patients reel at the prospect of heavy financial burdens. To help patients and programs meet the challenges of affording cancer treatments, community cancer centers are expanding the role of financial advocates in their organizations.

Results from the phase III IMpower130 trial demonstrated a statistically significant improvement in both progression-free survival and overall survival with a triplet regimen of&nbsp;atezolizumab, carboplatin, and nab-paclitaxel compared with chemotherapy alone in patients with previously untreated stage IV nonsquamous non&ndash;small cell lung cancer.

Among patients with advanced solid tumors associated with <em>NTRK</em> gene fusions, more than half had responses to&nbsp;the small-molecule inhibitor entrectinib, according to an integrated analysis of 3 clinical trials presented at the 2018 ESMO Annual Congress.

Larotrectinib induced an objective response rate of 80% in patients with advanced solid tumors who harbored&nbsp;<em>NTRK&nbsp;</em>gene fusions, according to results pooled from 3 small trials of the TRK inhibitor. Results were presented during the 2018 ESMO Congress.