It’s Complicated Navigating Targeted Therapies for Lung Cancer

Dr Mark Kris explains how the growing number of choices and targets is making it harder to select the best therapy for each patient.
https://www.medscape.com/viewarticle/its-complicated-navigating-targeted-therapies-lung-cancer-2025a10008bd?src=soc_yt

-- TRANSCRIPT --
Hello, this is Mark Kris, from Memorial Sloan Kettering, speaking to you today about my experience at a recent meeting of thoracic medical oncologists during the IASLC 2025 Targeted Therapies of Lung Cancer Meeting in Huntington Beach, California.

If I could set a theme for that meeting, it would be: It's complicated. The speakers [reiterated] that, with so many more choices and targets, choosing the best therapy for a patient is becoming much more difficult.

However, because we have more ways of fighting these cancers, we have a better chance of helping patients. I think you've heard me say before, “Better for patients, tougher for oncologists.” That's okay. That's what we signed up for.

I'd like to talk about the different stages of lung cancer and start with metastatic cancer. What is the initial treatment? As the meeting went on, it became tough to make any generalizations there. I'd like to make a couple, and we'll see if you agree, but I think this is a reasonable way to move forward.

For targets with a high likelihood of benefit and excellent tolerability — such as EGFR, ALK, ROS1, RET, and NTRK — when you find them in the face of metastatic lung cancer, I think there's general agreement that you would start with a targeted therapy. Response rates for all these [are] in excess of 75%, and tolerability is decent.

The issue comes, however, for the duration of therapy. I think the sad conclusion from all these drugs is that, no matter how good they are, absolutely none are curative. What do we do? What can we add?

We don't have much here, but one piece of data we do have comes with EGFR. If you add a standard chemotherapy, and we have randomized clinical trial data for this, you can improve the duration of response and the progression-free survival.

Many folks have said that this may not be the most appropriate endpoint, but I really would like to challenge that, and I'd like to do so on several levels. The first is that the recurrence of the cancer is absolutely devastating to the person with the cancer. People have so many negative thoughts at the diagnosis, and then after receiving agents like osimertinib or lorlatinib that give a great response and are very tolerable, you're taken off that very negative feeling.

When it comes back, though, all those negative feelings return. Every recurrence and progression is absolutely devastating to a patient. It reinforces in a very strong way that they have a deadly cancer. Preventing recurrence and delaying recurrence is very important.

Transcript in its entirety can be found by clicking here:
https://www.medscape.com/viewarticle/its-complicated-navigating-targeted-therapies-lung-cancer-2025a10008bd?src=soc_yt