2020 Ushers in Newfound Adjustments, Applications in Lung Cancer

Mark G. Kris, MD

The coronavirus disease 2019 (COVID-19) pandemic has become another potential complication for patients with lung cancer, said Mark G. Kris, MD, who added that although the pandemic has disrupted patient care, it has yet to stunt scientific collaboration. 

Such a claim is best evidenced by the transition from large in-person medical meetings to virtual platforms, including that of the 15th Annual New York Lung Cancers Symposium. 

“This year’s NY Lung meeting was different. I don’t think anybody would have expected we’d be in the place we are today,” said Kris, who served as the co-chair of the meeting. “[However,] we had broad representation of the entire community of practitioners treating [patients with] lung cancer. One thing you’ll find [at NY Lung], which you may not find in other meetings, is the opportunity to hear how New York doctors are treating patients with lung cancers today [with] case presentations from institutions in the metropolitan area. People are really open about what they did, what they learned, and [they were] anxious to share that.”

In an interview with OncLive^®, Kris, a medical oncologist, William and Joy Ruane Chair in Thoracic Oncology, Memorial Sloan Kettering Cancer Center (MSK), discussed the strengths of this year’s New York Lung Cancers Symposium, the advances that have been made over the past year, and potential routes forward in advancing the field of lung cancer.  

OncLive^®: What were you most excited to hear about at the 15th Annual New York Lung Cancers Symposium? 

Kris: Although we have this overarching concern about COVID-19 and the impact it has had on the lives of our patients and families and all of us, one of the key messages was that COVID-19 is another complication of lung cancer. The culprit here is lung cancer. We had discussions and presentations about some of the most important issues in lung cancer. Of my patients who died from lung cancer this year, all but 1 or 2 died from lung cancer, not from COVID-19. Our problem is lung cancer and the horrible threat it poses to our patients and what we can do to lessen that threat. 

A lot of very good information has come forward this year regarding ways to move forward. We have had new drugs approved and new information about using targeted therapies in the adjuvant setting, which will change the whole process for how we treat patients in the adjuvant setting. [We’ve also seen] the use of newer technologies. We had a special session on how our practices have changed due to the COVID-19 crisis, and also the use of things like cell free DNA, not just for diagnostic purposes, but also to help us monitor care and to help us guide therapy. All of these things [were covered at the meeting]. We had some great international and national speakers, and it’s one of the best groups we’ve ever had. It’s a shame everyone couldn’t be there to meet them in person.

Of the key developments that have been made in 2020, what has the potential to make the greatest impact on the paradigm?

The first is the ADAURA trial, which evaluated osimertinib [Tagrisso] in patients with completely resected lung cancer that harbors an EGFR mutation. People were very impressed by the dramatic benefit in event-free survival for those patients. [Those data] were game changing, not only for those patients with EGFR mutations, but it’s also going to make people think about looking at targeted therapy for patients with earlier stages and not just in [the] surgical [setting].

The next step is going to be [looking at] using targeted therapy in patients with locally advanced disease that are getting concurrent chemotherapy and radiation. Targeted therapies are going to be important in those patients’ care. This discussion with osimertinib in the surgery setting is going to lead to those other discussions. 

What has it been like to be a part of a team that has contributed so much to the field of targeted therapy in lung cancer?

I’ve been very lucky to work at MSK where my colleagues, many of whom [spoke at the meeting] have been involved in the approval of new drugs, such as selpercatinib [Retevmo]. Having more targeted therapies for [patients with] RET or MET mutations is very exciting. It’s really a kind of a dream come true that these drugs are being approved. 

If you had to describe the impact of COVID-19 on the lung cancer space over these past few months, how would you do so?

It’s been a horrible complication. We spend all this time trying to mitigate nausea and neutropenia, and then suddenly, our patients and their families had this put upon them and tremendous stress, and disruption in their care plans. There’s been a struggle to try to maintain their care. [We spend] weeks and months to put these plans together [with patients and their families], and suddenly [their family members or care takers can’t accompany them to the hospital]. 

To hear what the doctors are saying, to go over a scan report and make sure you understand it [can be difficult alone]. Here in Manhattan, [family members] have no waiting room. They can’t go to Starbucks, they can’t go in the diner on the corner, it’s all gone. It’s just a horrible stress on our patients. Then, of course, there’s the change in our practices and a physician I work with led a session at the meeting about how our practices have changed and how the practice of oncology has changed. 

Where do you hope the field of lung cancer will be in the next few years?

My hope is that we will be able to come up with ways to use all of the different tools that we have now to treat each and every patient. For example, somebody with metastatic lung cancer 5 or 10 years ago [would receive] chemotherapy. Now, [we have to determine whether to give] an antiangiogenic drug with chemotherapy. We also now have the opportunity to give patients a checkpoint inhibitor with an antiangiogenic drug and chemotherapy. 

We also have to make sure we look for [potential] targets for targeted therapy. All this has to come together for that individual patient, and that’s our challenge right now. We have so many opportunities, but [we have to] make sure that each patient has these opportunities. [These considerations have to be made] at every decision point of their illness too; it’s really complicated now. I’m hopeful that some of the discussions that [happened] at the meeting [gave] people some direction. I don’t think we have all the answers, but we [did spark] a discussion about making sure all the options are on the table at all times.

What distinguishes the NY Lung meeting from other medical meetings?

We [have] a whole bunch of case presentations, and even individual cases by some members. We also had different points of view [weighing in on those cases]. [For example], the moderator [would act as the] treating physician and synthesize the presentations and make a decision for that patient and talk about how they came to that decision. That’s kind of a unique way of discussing a lot of issues; [the meeting is] not simply presentations of data from this and that clinical trial; a lot of the meeting is case based.