What Advances Have Been Made in Treating NSCLC?
Dr. Iams:
Broadly speaking, some of the biggest advancements in the treatment of patients with non-small cell lung cancer are targeted therapies, which are able to address specific mutations that arise in cells and lead to the development of lung cancer. Within the last year, we've had some really exciting developments within the field of targeted therapies for patients with non-small cell lung cancer. Two highlights are the first FDA approval of agents for patients with KRAS-G12C mutant non-small cell lung cancer, and for EGFR exon 20 insertion mutant non-small cell lung cancer. So just within the last year, we've had two new cancer mutations with targeted therapies available for our patients, both are approved in the second line or later. So, patients are to receive standard chemotherapy with or without immunotherapy or immunotherapy alone, before those treatments. But really so much progress has been made in the treatment of patients with non-small cell lung cancer, through going after these mutations with specific targeted therapies and we're getting more and more every year.
What Is an Immune Checkpoint Inhibitor?
Dr. Iams:
An immune checkpoint inhibitor takes the brakes off the immune system. So there's two fundamental precepts to developing cancer. Number one, is that a normal cell acquires a mutation or multiple mutations that allow it to grow out of control. But number two is that a patient's immune system is not able to control and destroy that cancer. And immune checkpoint inhibitors are antibodies that are infused via the intravenous route. And they take down a checkpoint or a stopping point on the immune system. And so, it's a double negative, but by taking down the immune checkpoint, you actually push up and accelerate the immune system to attack and control the cancer.
The approval you are describing applies to a very big group of patients who were not eligible for immune checkpoint inhibitors previously. And this is patients with resected non-small cell lung cancer. Now their tumors have to exhibit certain markers to make them eligible, so not every individual with a surgically removed non-small cell lung cancer is eligible, but a big cohort is now eligible. They're the same drugs that have been approved for patients with stage four or metastatic non-small cell lung cancer. But the big update is they've been shown to reduce the risk of recurrence over a period of time for patients with resected or surgically removed non-small cell lung cancer, who meet in certain stage requirements and certain tumor biomarker requirements. So, it's not everybody who was surgically removed, but a big cohort who's now eligible, who was not before.
Summary of Treatment Advances in Non-Small Cell Lung Cancer
Dr. Iams:
When I summarize treatment advances over the past year, for example, in patients with non-small cell lung cancer, the big two, or the two that apply to the largest patient populations are the application of immune checkpoint inhibitors for a group of individuals who qualify, with surgically removed non-small cell lung cancer. And one we haven't discussed, which is the application and FDA approval of a targeted therapy for EGFR mutations, not exon 20 mutations, but the more typical exon 19 deletion and L858R mutations in individuals who had a surgically removed non-small cell lung cancer. And the reason I call out those two new medications, or rather new applications of existing medications for patients with surgically removed non-small cell lung cancer, is because they're the biggest patient cohorts that are eligible for treatment of these types who never were before.
