When it comes to targeted therapies for the treatment of lung cancer, “the future of precision medicine is here,” as Dr. Ravi Salgia explained during the CURE® Educated Patient® Lung Cancer Summit.
Salgia is a medical oncologist who serves as professor and chair in the Department of Medical Oncology and Therapeutics Research as well as the Arthur & Rosalie Kaplan Chair in Medical Oncology at City of Hope Comprehensive Cancer Center in Duarte, California.
He explained his view that lung cancer is not just one disease, but rather one that encompasses a variety of genetic abnormalities — differences that are now targeted by various modern therapies.
“Lung cancer is no longer lung cancer in my mind,” he said. “It’s a cancer that arises in the lung that has various characteristics … [and] so all of that has to factor into our decision making, we must make sure that molecular analysis is done. And targeted therapeutics, I’m very happy to say, have revolutionized our treatment. But we need to continue to strive to be better and better. And precision medicine will help us deliver better care.”
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The revolution, Salgia said, has already arrived.
“You can have EGFR mutations, KRAS alterations, but you can also have MET mutations, MET amplification, MET fusions, BRAF alterations … [and] you have medications such as Tagrisso [osimertinib] and others for EGFR, for ALK rearrangement you have Lobrena [lorlatinib] and other medications, [treatments for] ROS1 [rearrangements] and so forth. And it is important to talk to your physician and health care provider about which medication is the right one for you. At the same time, what are the toxicities?”
Advancements in ALK Inhibitors
Xalkori (crizotinib), approved in 2013, was found to confer a median progression-free survival (the time a patient lives without their disease spreading or worsening) of 10.9 months. By contrast, Lorbrena, approved in 2021, resulted in a median progression-free survival of 33.2 months, according to Salgia’s presentation.
Xalkori and Lorbrena are both ALK inhibitors, drugs that inhibit the growth of tumor cells that overexpress ALK, a protein that controls cell growth.
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Earlier this year, the FDA approved the ALK inhibitor Alecensa for the treatment of patients with ALK-positive non-small cell lung cancer that was at least 4 centimeters and had been surgically removed — making it, according to Alecensa manufacturer Genentech, the first ALK inhibitor approved for patients with early-stage NSCLC that underwent surgical resection, or removal.
Such treatments are part of the future of precision medicine, as Salgia explained.
“We can take serum or plasma samples and fluid samples, [we can] take tumor tissue, we’re working on stool and urine sample as well,” said Salgia. “Then, you do this biopsy analysis and or the liquid biopsy analysis such as [of] the blood or even CSF or cerebrospinal fluid [and you] look at the various mutations that can happen, that is the genetic and the non-genetic mechanisms, then ultimately try to look at what are the various medications that one will respond to, and I think, then, ultimately come up with the drug matching [the disease]. That’s really what we’re committed to being in terms of the future of precision medicine.”
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