This past weekend Chicago hosted the annual “Super Bowl” of cancer meetings, the ASCO (American Society of Clinical Oncology) Annual Meeting. Over 35,000 attendees learned about cutting-edge clinical cancer research for many different types of cancers. Here are the key lung cancer highlights you need to know.
Small Cell Lung Cancer
Some of the most exciting news came from possible new treatment options on the horizon for small cell lung cancer (SCLC)! No major treatment advances have been seen in SCLC for the past 30 years, but we are hopeful that this will soon change.
Rova-T study results showing that the drug is most effective for patients whose tumors have DLL3.
Rova – T: One of the highlighted presentations was the results of Phase I clinical trial on a new drug named rovalpituzumab tesirine (aka “Rova-T”). This drug is an antibody-drug-conjugate which means that a targeted antibody takes a “warhead” or toxic compound right to the tumor cells.
The antibody in this case targets the DLL3 protein and the data clearly showed that the drug is most effective for patients whose tumors have DLL3 (see photo). This is about 70% of people with SCLC. Based on the promising data from this study, a nationwide Phase II clinical trial called TRINITY is now accepting patients whose cancer has grown after two rounds of prior therapy (click here for more information). All patients will have a test to confirm their cancer has DLL3 protein. If it gets approved, this could be the first targeted therapy for small cell lung cancer.
Immunotherapy: We have been asked frequently on our Opdivo blog if immunotherapies are being used in SCLC. There are a number of ongoing clinical trials and now there is some early data. A trial was presented that compared Opdivo (nivolumab) with two combinations of Opdivo and Yervoy (ipilimumab) together at different doses. There is a reason to think a combination could work as Opdivo and Yervoy are currently approved together in metastatic melanoma.
Opdivo alone resulted in a 10% response and the combinations resulted in a 20% response, although there was more toxicity (side effects) when using both treatments at the same time. Similar to non-small cell lung cancer (NSCLC), the patients who responded well showed long-term responses. One of the dose combinations is being moved into larger, randomized trials. So consider this early days for immunotherapy in SCLC, but the speaker referred to it as “quite hopeful” for the future.
Non-Small Cell Lung Cancer
A lot of the work presented in NSCLC focused on new Targeted Therapies.
Over 35,000 attended the annual ASCO conference.
ALK: One of the most notable studies we saw compared the ALK inhibitor, Alecensa (alectinib) to Xalkori (crizitonib) for first-line treatment of cancers with an ALK mutation. This trial was done in Japan and it has worldwide data that has not yet been presented. However, in this trial of about 200, patients on Alecensa both survived longer and had fewer side effects than those on Xalkori. So this drug may become the new standard of care for ALK+ patients.
It is important to note that Alecensa and a new drug called brigatinib can enter the brain to fight brain metastases. Brigatinib is not as far along in development, but data presented in the same session showed it may also be an effective therapy for cancers with ALK mutations.
EGFR: Companies are developing new generations of therapies that inhibit EGFR better and/or can work after cancer comes back on EGFR therapy. Early data was shown for two drugs that demonstrated some activity and success in different types of hard-to-treat metastases (leptomeningeal and brain).
Other mutations – BRAF and MET: There are also new drugs and drug combinations being studied for other mutations in lung cancer. For patients whose cancer has a mutation in the BRAF gene (at a specific site called V600E that happens in 1-2% of NSCLC and is very common in melanoma), a combination of two drugs called Taflinar (dabrafinib) and Mekinist (trametinib) was studied. This combination is already used in metastatic melanoma. This is an early time point and a small study, but there was a 63% overall response rate showing that this is a promising combination in NSCLC too, although there was a high rate of side effects.
For patients with MET mutations (in a spot called exon 14, found in 3-4% of nonsquamous NSCLC and also in 20-30% of sarcomatoid carcinomas), early data (only 18 patients) showed that Xalkori (crizotinib; a known ALK inhibitor but it can also inhibit MET and ROS) may be a good option for these patients. For all of these drugs, studies are continuing to understand how to best treat patients with different types of genetic changes.
Interestingly, there were a few studies showing that molecular testing with liquid biopsies had a similar outcome to using tissue biopsy. This was shown both specifically for understanding resistance to EGFR-targeted therapies as well as more broadly for finding cancer mutations across tumor types.
Immunotherapy: In general, due to the long-term benefits of Opdivo (nivolumab) and Keytruda (pembrolizumab) seen in a small percentage of NSCLC (15-20%), researchers are trying to figure out if combining these with other drugs can improve the number of people who respond. These drugs are being combined with everything – other immunotherapies, targeted therapies, radiation, and chemo. There were many studies but it is still early days for these combinations and it remains to be seen how to best combine these drugs to improve patient care.
From a patient perspective, there was also an interesting talk on how patient reports of the side effects they were experiencing on a mobile app allowed clinicians to identify recurrences sooner and at lower cost. This actually led to improved survival. This study was done in France but the presenter said the software will be more widely available in 2017. Importantly for our community, this shows how significant your voice is in your treatment journey. Speaking up honestly about side-effects, how you are feeling and your concerns can make a major difference in your care.
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