New personalised therapies for lung cancer

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Published: 4 Jun 2017
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Dr Luis Raez - Memorial Cancer Institute, Hollywood, Florida, USA

Dr Luiz Raez speaks with ecancer at ASCO 2017 about new developments and discoveries in the field of personalised medicine, particularly in lung cancer patients.

He mentions that the standard of care currently includes testing new lung cancer patients for molecular markers, and that in 20% of patients, markers are present, allowing for personalised therapy.

The breadth and number of abstracts dealing with immunotherapy treatments at ASCO 2017 is promising for the field, he says.

 

This is a very exciting meeting for us because we are moving forwards with new developments and discoveries in personalised medicine. As we know, it’s standard of care now to have molecular markers tested in new lung cancer patients and that is standard of care now. Now maybe we find molecular markers in 20% of lung cancer patients so these patients have a personalised approach, a specific approach that is six lung cancer oral medications that can be given one to each patient based on the gene that the patient has. But we still have 80% of lung cancer patients that do not have these genes and we have to give chemotherapy or even immunotherapy.

Immunotherapy is very exciting for us because it’s non-toxic, it’s a good response but it doesn’t have that personalised approach yet. That’s why we’re working very hard to find markers for immunotherapy. So, for example, I do research in trying to get the marker for immunotherapy called PD-L1 that is frustrating for us because after so many years to try to implement this marker that we do in the tissue or the tumour we haven’t found an accurate marker. So part of my research, for example, is we do the marker in blood. We’re trying to see if maybe doing the PD-L1 in blood can be validated and can be more specific than the marker in tissue that has not been yet fully applied because some drugs are approved by the FDA without markers, others are approved with markers and that’s a little bit confusing. So that’s why this issue with the personalised medicine is very exciting.

Tuesday is the main lung cancer session, there is a good chance that they will be presenting one of the ALK drugs that is going to move to the front line because it has proved efficacy, it’s alectinib. That is why it’s very good, it’s probably the most important lung cancer presentation that we’re going to have, that these patients now can benefit from this drug. We have now four drugs for this ALK but this drug is interesting because the drugs that we currently use don’t protect the brain of the patient so the patient, despite the fact that they get the personalised medicine, excellent treatment, they respond very well, but they still have a lot of brain metastases. One of the benefits of this new drug is that the patients are going to be able to have benefits from the pill and they will not get brain metastases anymore. So that’s something very interesting for us.

That’s, for example, one of the presentations in the main lung cancer session. Another development is that in the same line there is another marker called EGFR, there are four drugs approved. Now this new generation of EGFR inhibitors like osimertinib, they can go to the brain and protect the patient because the original treatments that we used to use for these markers, for EGFR, didn’t go to the brain. So last year in ASCO we had two presentations where this drug shows it has an effect in the brain to protect the patients and this year we’re going to have that again. So that’s why this is another important landmark for us because we have these studies.

Also there are in ASCO more than 140 presentations of immunotherapy. As I said before, immunotherapy is not as specific yet because we don’t have the marker but still you cannot discard the fact that we have so many presentations in all other cancers. Particularly in lung cancer it’s important for us because immunotherapy just was approved for new patients by the FDA three weeks ago. Three weeks ago immunotherapy for the first time in history is going to be used now for every new lung cancer patient. That’s very important that maybe we’re doing this today, maybe a lot of people don’t know any new lung cancer patient with metastatic disease, that are the majority of the patients all over the world, they will not only now get chemotherapy, they will get immunotherapy if they don’t have any of these genetic markers. That is very important because immunotherapy adds to the benefit of the chemotherapy in these patients.

Then we want to discuss several of these abstracts from follow-ups from these studies in this meeting. That’s why this is a very exciting meeting because we emphasise personalised medicine, trying to find the right medicine for each patient, not only in lung cancer but in all the cancers. That’s why we’re very happy with this and these developments.