番茄社区

The is the stage for presenting many of the most impactful advancements in cancer research -- including in lung cancer.

In this third of four exclusive episodes, 番茄社区 brought together three leaders in the field -- moderator Roy S. Herbst, MD, PhD, of Yale Cancer Center in New Haven, Connecticut, is joined by Jorge Nieva, MD, of the Keck School of Medicine of USC in Los Angeles, and Sarah Goldberg, MD, also of Yale Cancer Center -- for a roundtable discussion reviewing the unmet needs, including strategies to manage brain metastases in non-small cell lung cancer patients.

Following is a transcript of their remarks:

Herbst: Welcome to our roundtable on lung cancer here in Chicago at ASCO 2022. I'm Dr. Roy Herbst from the Yale Cancer Center. I'm also joined by my colleague, Dr. Sarah Goldberg from the Yale Cancer Center, and Dr. Jorge Nieva from the University of Southern California.

So, there's so many posters, oral sessions, discussions, but is there anything that's overlooked? Is there an unmet need, some area in lung cancer, Sarah, that you'd like to see more of?

Goldberg: Yeah. So there's probably a lot of things that we can say in this space, because there's always so much more that we can do. I guess something that I've worked a lot on and I'm excited to start seeing more of is studies in patients with brain metastases.

This is a really common problem. And these studies are, I think really exciting because they specifically focused on patients with untreated active brain metastases -- so different than other studies that we've seen where they might show the data in patients with brain metastases, but those patients all have had previous treatment to their brain mets, usually with radiation. So the studies that I'm discussing are , the KRAS G12C inhibitor, in patients with untreated brain metastases, and then [Tecentriq] in patients with untreated brain mets.

And I think the data is showing us that patients with brain metastasis can do what looks to be just as well as patients without untreated brain metastasis. So the activity in the brain seems to be similar. And I think this is the theme we're seeing more and more now, where when our drugs work systemically, they tend to work in the brain as well. But I think it's something that's really important to still keep an eye on and to focus on.

And you can't just assume that all drugs are going to work in the brain, but many of the drugs that we use do have activity in the brain and those patients don't need to be excluded. And there may be a day that we don't need to give local therapy depending on the specifics of the drug

Herbst: By local therapy, you mean whole brain radiation?

Goldberg: Exactly.

Herbst: Which can have some cognitive effects.

Goldberg: Exactly.

Herbst: So that's great. And do all drugs work in the brain or you have to test each one individually?

Goldberg: I think we have to test each one individually. I think there are preclinical studies that you can do, trying to understand the effects in the brain. But I think in the end, you really want to see if there is activity in patients with untreated brain metastases.

So I think you can have more confidence from the preclinical studies, but really, I think it's a situation where you really need to look at the patients and see if there's activity there as long as there's enough preclinical data to support moving that forward.

Herbst: Now there are two drugs against KRAS -- now the drug you're talking about still in clinical trials, adagrasib, but what about sotorasib [Lumakras]?

Goldberg: Yeah, so sotorasib is, as you mentioned, approved for patients with lung cancer with KRAS G12C mutations. There is a study that is ongoing, that is enrolling patients with untreated brain metastases. So we hopefully will have some data for that drug in patients with brain mets soon, but we don't have data yet to say if it is clearly effective in the brain.

Herbst: Right. And what percentage of patients with lung cancer do recur in the brain?

Goldberg: At diagnosis it's somewhere between 25 and 40% of patients have brain metastases. But then as time goes on, more and more patients will develop brain metastases. It's probably different for different subsets of patients and depending on how long patients are living, but clearly an area of importance to patients with lung cancer. And I think still, even though we're seeing these great studies, still an area of unmet need where we need to do some more work.

Herbst: Excellent. And you know, Sarah and I work together on our Lung SPORE [Specialized Program of Research Excellence], and I can tell you our advocates constantly tell us that they're worried about brain metastases. The patients -- there's a lot of morbidity.

Okay, Jorge, I haven't forgotten you. So you've had a little time to think here. So something that's missing that you'd like to see more of at ASCO?

Nieva: Well, the first thing, of course, Roy, that I think we're missing is getting credit for how much progress we've made the past 20 years. So, when I joined ASCO over 20 years ago, the lung cancer incidence rate and the lung cancer death rate were almost the same number. And I'm sure you remember those days where it seemed like almost everybody who got lung cancer, it looked like they were going to ultimately succumb to their lung cancer, and it was terrible.

And you look now at the data from the American Cancer Society. And now we're seeing 30-plus percent of patients who are diagnosed with lung cancer are not dying. Two, the incidence number is much higher now than the lung cancer death number -- by about a hundred thousand. And that's real progress.

And I think we forget that all this work that we're doing and everything that we do at this ASCO meeting and the important work that Dr. Goldberg and others are doing, really is making a big difference in the lives of patients. And so we need to go out and keep doing that.

And then the other thing that I think we need to realize is that, going along with the theme of the meeting about equity and being able to deliver care to everybody, is we need to pay a little bit more attention to financial toxicity. And we need to start thinking about, how do we get these drugs to patients, and how do we get these drugs to patients in a way that doesn't impact all the other aspects of their life. And does so in a way that lets them do things like keep working and keep living the life.

So I love all these oral agents that we're seeing now that let people be minimally impacted by the burdens of treatment.

Herbst: I couldn't agree more. So we need more of those. I think what I'd like to see more of is maybe a few more presentations on integration of care. Multi-modality. We tend to have, it could be a little bit more surgical research and radiation oncology integration. We did have one session today, but I thought it could have been a little bit more ... involvement by some of the other disciplines. I think at ASCO, we have a lot of medical oncologists here. I'd like to see more surgeons and radiation oncologists.

Goldberg: Yeah. It's becoming so important that we even more than before, that we all work together to take care of patients, so we should all work together too.

Herbst: And maybe the whole care team, the social workers. You know, the nurse practitioners. It really takes the community now, given the complexity of profiling and understanding the markers and then treating patients in real time.

Great. Well, thank you both very much.

Watch episode one in this series: Neoadjuvant Chemo Plus Immunotherapy in Resectable NSCLC

Watch episode two in this series: Top Takeaways in Lung Cancer From ASCO 2022

Watch episode four in this series: ASCO 2032: What Will Be the Big Story in Lung Cancer?

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