Promising Emerging Classes of Therapies in NSCLC

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David Gandara, MD, Corey J. Langer, MD, Anne S. Tsao, MD, Alan B. Sandler, MD, and Mark A. Socinski, MD, each provide their opinion on the most promising emerging class of therapeutics in non-small cell lung cancer (NSCLC).

Based on the emergence of ipilimumab in melanoma, Langer believes that immunologic therapies will play a promising role in the future. He adds that intriguing phase II data suggests that combining carboplatin/paclitaxel chemotherapy with concurrent or phased ipilimumab may be beneficial in advanced NSCLC. Additionally, promising early results have been seen with anti-PD-1 agents.

Tsao believes that second generation ALK inhibitors will be influential in 2013. She cites an ASCO presentation that showed an ALK inhibitor crossing the blood-brain barrier in patients who received prior crizotinib. Unfortunately, Langer notes, this trial did not receive as much attention as it should have.

Gandara mentions that MEK inhibitors showed profound results with a taxane and docetaxel. It remains to be seen, Gandara says, if a tolerable combination can be identified. Gandara points out that impressive findings were demonstrated by a trial presented at ASCO that compared docetaxel alone to the MEK inhibitor selumetinib plus docetaxel in KRAS mutant NSCLC.

Sandler believes that c-Met inhibitors such as tivantinib may still have potential in lung cancer, even though they have not shown benefit yet. At this point, he feels it's still very early and his hopes are high.

Socinski says that heat shock protein inhibitors could potentially have a broad spectrum affect in lung cancer. Some oncogenes, Socinski says, are more dependent on heat shock proteins than others, which could provide an advantage. Further, the possibility remains that a two-drug strategy could be superior to one in the second-line setting.

Gandara conclude by noting that with all of the new emerging therapies, there will not be just one treatment that provides benefit for all patients. Overall, the panel also agrees that traditional cytotoxic chemotherapy agents will also maintain a role in the future. Additionally, he notes, biomarkers can be used to select chemotherapy and should be a focus in the future.