Changing at the Speed of Light

TWENTY YEARS AGO, PATIENTS who received an advanced lung cancer diagnosis had limited treatment options. The conversation with their oncologist likely led to this question: What platinum-based chemotherapy regimen should we use?

Because of evolving research and new treatment options, that conversation has drastically changed. Patients may now ask, “What does my gene sequencing data point to?” Genomic testing is used to help identify unique DNA changes that can be inherited or developed over a person’s lifetime and present only in the tumor. In recent years, researchers have begun to use genomic testing as a tool to help personalize treatment regimens for individuals and target specific genes or mutations.

Cancer care is changing at the speed of light. For instance, EGFR sequencing has taught researchers which cancers will respond to drugs that inhibit EGFR, a protein found on the surface of cells that can make them grow faster. However, sometimes these drugs stop working, which led to the discovery of the resistant-causing T790M mutation, detectable in the EGFR gene after drug resistance develops. A blood test can now detect this mutation, and there is even a specific drug, Tagrisso (osimertinib), approved by the Food and Drug Administration to target it. Most recently, clinical trial results show that Tagrisso is actually better to use in most people as initial therapy with EGFR mutations; however, if they do not have the mutation, they may qualify for immunotherapy.

The use of immunologic therapies have helped change the landscape of treatment and are now being used in combination with chemotherapy and other biological therapies. Within these pages, two features examine the newest developments being seen in clinical trials and what this news means for patients with lung cancer. The value of early palliative care, commonly known as supportive care, among people with advanced-stage disease is also explored. Recent studies find it to not only be helpful in alleviating the physical side effects, but also the psychological, such as depression.

But there are a few barriers. How can a patient stay on top of the everevolving developments? And how does the oncologist in a smaller practice, that sees all type of cancers, versus the academic oncologist navigate this?

Patients should ask questions and read patient-friendly resources that discuss the latest in cancer treatment, such as CURE®. Community and academic oncologists can bridge gaps through data sharing and working with one another.

Lung cancer has gone from being a dismal diagnosis — it still is very serious — to one that is the poster child for targeted therapeutics, immunotherapy and molecular diagnostics. These advancements are just the beginning.

DEBU TRIPATHY, M.D.

Editor-in-Chief Professor of Medicine Chair, Department of Breast Medical Oncology The University of Texas MD Anderson Cancer Center