Impact of biomarker-integrated approaches of targeted therapy for lung cancer elimination

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Published: 26 Jun 2014
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Prof Waun Ki Hong - University of Texas MD Anderson Cancer Center, Houston, USA

Prof Hong talks to ecancertv at the WIN Symposium 2014 about the impact of the biomarker-integrated approaches of targeted therapy for lung cancer elimination (BATTLE) I trial and how this has influenced the design of the BATTLE 2 clinical study.

The topic I addressed this morning was where we stand in terms of challenges, opportunities of the targeted therapy in lung cancer after a decade of the BATTLE-1 trial we initiated.

What can you tell us about the first BATTLE trial?

BATTLE means the biomarkers associated with targeted therapy of lung cancer elimination as an acronym. Basically cancer is a genetic disease and multiple genetic changes are, then later on they manifest as the phenotype as a cancer. In the old days we used to treat those patients with surgery, chemotherapy and radiation treatment; the results of that kind of traditional treatment reached a plateau and still a lot of lung cancer patients are dying. More recently, I would say more recently, about 10-15 years ago, we discovered more and more genomic changes of tumour tissue. Then they identified some cancer driver genes and that is really progressing towards the cancer. So the BATTLE theme is how you can identify that kind of genetic event on the tumour tissue and then treat it with a matched targeted agent. So initially we conducted the BATTLE-1 trial and despite tremendous scepticism what we demonstrated is a biopsy mandated molecular marker driven the trial can be done. Now it’s a biopsy driven biomarker integrated trial even beyond lung cancer is so considered treatment.

What were the first results of the trial and what did they mean?

It ultimately will make the practice in the cancer community and is still on the development. What we have found is that we did a biopsy and then we can visualise some genetic changes. That genetic change, basically, is the cancer driver and that cancer driver can be killed by a targeted matched agent. What we found is a single agent is not good enough and ultimately we have to give some combination agent. That shows us some patients some substantial benefit and associated with the survival benefit and that can be ultimately this pride in the cancer practice and community.

Is the BATTLE-2 study underway?

The BATTLE-2 study, in fact, there’s two stages, stage one and stage two. Stage one of the BATTLE-2 study is completed and then we are in the process of analysing some molecular data and clinical outcomes and then we designed the study stage two as adaptive randomisation and there will be a launch soon.

What were the main conclusions of your presentation?

The main point is that it’s changing the paradigm of cancer treatment. In the old days we used to treat patients empirically and that is like shooting in the dark. We shouldn’t do it as, first of all, it’s expensive and patients don’t get the benefit; it’s just a guessing game. I think we should avoid that kind of approach and if the paradigm changes we can really biopsy the tumour tissue and then analyse genetic changes and then find out which is the cancer driver and that cancer driver can be hijacked with a specifically targeted agent. It’s a bit too early to use in community practice but in the next five years I think it will be part of cancer practice in the community.

The WIN consortium is, in my opinion, really the outstanding organisation and the scientific presentations the last two days, I can say, were really superb and top notch speakers and the quality of the presentation was also outstanding. Also, the important thing is there is a global effort and multi-national cancer experts participating. So I am very optimistic about the way WIN is articulating its scientific agenda and ultimately it will make an impact for the patients.