ASCO 2021 – David T. Cooke
David T. Cooke talks about health equity and health disparities relating to lung cancer management in the western world. He explains which factors based on ethnicity are likely to affect outcomes of lung cancer patients and how health disparities might be tackled in the long run at the public health level.
Here is the full ASCO 2021 report.
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Opening up new vistas for patients with SCLC
Concurrent chemo-radiation with a platinum-etoposide backbone constitutes the standard of care in limited-stage small-cell lung cancer (LS-SCLC). Here, cisplatin is traditionally the preferred platinum agent. However, data on the comparative efficacy of the less toxic carboplatin in this setting are lacking. To fill this gap, Azar et al. conducted a retrospective study based on the National VA Cancer Cube database.
Enhancing immunosupportive mechanisms via anti-angiogenesis
Treatment with anti-angiogenic agents offers potential in the management of patients progressing on immune checkpoint inhibitors as it has been shown that excessive VEGF production can create an immunosuppressive tumor microenvironment by modulation of immune cell function and reduction of immune cell access [1-3]. This might contribute to checkpoint inhibitor resistance and prime the tumor for anti-angiogenic therapy.
How does checkpoint inhibition perform in the setting of oncogene-driven lung cancer?
Retrospective analyses have demonstrated limited activity of immune checkpoint inhibitors (CPIs) in patients with actionable oncogenic driver mutations. In similar vein, the randomized controlled IMpower150 and IMpower130 studies revealed no survival benefit of adding CPIs to platinum doublets in patients who harbored EGFR and ALK aberrations.
Immunotherapy: from predictive factors to antibiotics
Based on the randomized, phase III CheckMate 9LA study, the first-line regimen of nivolumab plus ipilimumab and two cycles of chemotherapy has been approved in the indication of metastatic NSCLC without EGFR or ALK aberrations in many countries. CheckMate 9LA included approximately 360 patients with stage IV or recurrent disease in each arm and demonstrated significant OS, PFS, and ORR improvements with the immunotherapy-based regimen compared to four cycles of standard chemotherapy.
KRAS, MET, ROS1, HER2: current perspectives
Approximately 13 % of patients with adenocarcinoma of the lung harbor the KRASG12C mutation. To date, no agent targeting this oncogenic driver has been licensed, although there is a need to improve outcomes in this population after progression on first-line treatment encompassing immune checkpoint inhibitors. The first-in-class, irreversible, selective KRASG12C inhibitor sotorasib has demonstrated durable clinical benefit in pretreated patients with KRASG12C-mutated, locally advanced or metastatic NSCLC in the single-arm phase II CodeBreaK100 trial.
EGFR-mutant disease: strategies against sensitizing and resistance-mediating mutations
EGFR tyrosine kinase inhibitors (TKIs) are the established first-line option in patients with EGFR-mutated NSCLC, although resistance inevitably develops in the long run. A wide variety of genomic alterations has been identified in the context of EGFR TKI resistance. HER3, which is expressed in 83 % of NSCLC tumors, is not known to confer resistance to EGFR TKI therapy in EGFR-mutant disease.
