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Accreditation/ Credit Designation

This activity is not approved for AMA PRA Category 1 Credit™


Acknowledgment of Commercial Support

This activity is supported by an educational grant from Lilly. For further information concerning Lilly grant funding, visit www.lillygrantoffice.com


Oncology Best Practice™: Informed Decision Making in Advanced NSCLC: Matching Treatment to Patient Pulse — Recap


PER Pulse™ Recap



1 of 3
PER Pulse Recap

 
Frontline Management of Patients with Advanced, Squamous NSCLC
 
This series of Oncology Best Practice features key lung cancer experts David R. Gandara, MD; Barbara Gitlitz, MD; Suresh Ramalingam, MD; and Jonathan Riess, MD, MS, addressing best practices for the management of patients with lung cancer, as well as emerging therapeutic paradigms. This first of 3 PER Pulse Recaps from the Oncology Best Practice series focuses on first-line therapy for patients with advanced non–small cell lung cancer (NSCLC) and squamous histology.
 
  • In contrast to patients with adenocarcinoma, molecular testing has not been a standard approach in patients with newly diagnosed squamous NSCLC. However, in patients with a never-smoking history, who have small biopsy specimens, or whose disease shows mixed histology, molecular testing for oncogenic drivers is a reasonable consideration.
  • Platinum-based doublet chemotherapy is a current standard of care, and necitumumab/chemotherapy may also be considered, depending on a patient’s age, performance status, and goals of therapy.
  • Immunotherapy may play an increasing role in frontline management. The KEYNOTE-024 trial, carried out in patients whose tumors had a PD-L1 expression level ≥50%, showed improved progression-free survival, overall survival, and response rate with pembrolizumab compared with standard platinum-based chemotherapy.
For additional commentary about this topic and others, visit www.gotoper.com to access downloadable slides from Oncology Best Practice: Informed Decision Making in Advanced NSCLC: Matching Treatment to Patient.




2 of 3
PER Pulse Recap

 
Management of Patients with Advanced, Squamous NSCLC: Second-Line Therapy and Beyond
 
This series of Oncology Best Practice features key lung cancer experts David R. Gandara, MD; Barbara Gitlitz, MD; Suresh Ramalingam, MD; and Jonathan Riess, MD, MS, addressing best practices for the management of patients with lung cancer, as well as emerging therapeutic paradigms. This second of 3 PER Pulse Recaps from the Oncology Best Practice series focuses on subsequent lines of therapy for patients with advanced non–small cell lung cancer (NSCLC) and squamous histology.
  • In patients who progress after platinum-based therapy, immunotherapy is a current standard, based on superior overall survival (OS) compared with docetaxel. Randomized data have demonstrated an OS benefit with nivolumab (CheckMate 017 trial), pembrolizumab (KEYNOTE-010 trial), and atezolizumab (POPLAR and OAK trials). The trials of nivolumab did not require PD-L1 expression, while the pembrolizumab trials and the current application for atezolizumab required PD-L1–positive disease.
  • Other options in subsequent lines of therapy include ramucirumab/docetaxel and afatinib. In the REVEL trial, which enrolled patients with both squamous and nonsquamous NSCLC who had received prior chemotherapy, the combination of ramucirumab/docetaxel yielded superior OS compared with docetaxel alone. The squamous-specific LUX-Lung 8 trial randomized patients to receive afatinib or erlotinib as second-line therapy, with afatinib yielding a higher OS compared with erlotinib.
For additional commentary about this topic and others, visit www.gotoper.com to access downloadable slides from Oncology Best Practice: Informed Decision Making in Advanced NSCLC: Matching Treatment to Patient.




3 of 3
PER Pulse Recap

 
Management of Patients with Previously Treated, Advanced, Nonsquamous NSCLC
 
This series of Oncology Best Practice features key lung cancer experts David R. Gandara, MD; Barbara Gitlitz, MD; Suresh Ramalingam, MD; and Jonathan Riess, MD, MS, addressing best practices for the management of patients with lung cancer, as well as emerging therapeutic paradigms. This third of 3 PER Pulse™ Recaps from the Oncology Best Practice series focuses on therapy for patients with previously treated, advanced non–small cell lung cancer (NSCLC) and nonsquamous histology.
  • The clinical vignette in this activity describes a patient with an activating mutation in the epidermal growth factor receptor (EGFR) gene who has received multiple lines of EGFR inhibitor therapy and subsequent chemotherapy.
  • In this setting, ramucirumab/docetaxel may be considered, and immunotherapy is also another potential approach. Key studies supporting ramucirumab/docetaxel (REVEL) and pembrolizumab (KEYNOTE-010) have been mentioned previously; in patients with nonsquamous NSCLC, the CheckMate 057 trial results demonstrated superior overall survival with nivolumab compared with docetaxel.
  • The subset of patients with EGFR mutations in the CheckMate 057 trial did not appear to obtain a survival benefit with nivolumab. Although experts would not refuse immunotherapy, the optimal application of immune checkpoint inhibitors in patients with oncogene-driven NSCLC remains a topic of investigation.
For additional commentary about this topic and others, visit www.gotoper.com to access downloadable slides from Oncology Best Practice: Informed Decision Making in Advanced NSCLC: Matching Treatment to Patient.





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