Keypoints:
• The importance of next-generation sequencing (NGS) and PD-L1 levels in treatment decision-making.
• Current treatment options for patients with high PD-L1 scores, including single-agent immunotherapy.
• Strategies for patients with low or intermediate PD-L1 scores, including chemotherapy combined with immunotherapy.
• Discussion on KRAS G12C and HER2 positive disease in second-line settings, including the latest approved therapies.
• Insights into the potential side effects and considerations when transitioning from immunotherapy to targeted therapies.
In this episode of the Oncology Brothers podcast, we had the privilege of hosting Dr. Mark Awad, a world-renowned thoracic medical oncologist from Memorial Sloan-Kettering. Our discussion centered around the treatment landscape for metastatic non-small cell lung cancer (NSCLC) without actionable mutations in frontline settings.
We began by emphasizing the importance of comprehensive next-generation sequencing (NGS) to rule out targetable mutations before selecting treatment options. In cases where no actionable mutations are found, we explored various treatment strategies, including chemotherapy combined with immunotherapy, single-agent immunotherapy, or dual checkpoint inhibitors. Dr. Awad highlighted the significance of the PD-L1 tumor proportion score in guiding treatment decisions, noting that patients with high PD-L1 levels may benefit from single-agent PD-1 inhibitors, while those with lower scores might require a combination of chemotherapy and immunotherapy.
We also delved into the ongoing debate surrounding the use of dual immunotherapy, particularly in patients with high-risk mutations like STK11 and KEEP1. Dr. Awad pointed out the lack of definitive prospective data to guide these decisions, underscoring the need for further research in this area.
As we transitioned to second-line treatment options, Dr. Awad discussed the importance of targeting specific alterations, such as KRAS G12C and HER2 mutations, and the available therapies for these conditions. He shared insights on the side effects and considerations for using KRAS G12C inhibitors like sotorasib and adagrasib, as well as the role of chemotherapy in the absence of actionable mutations.
In summary, this episode provided valuable insights into the complexities of treating metastatic NSCLC without actionable mutations, emphasizing the critical role of NGS testing and the need for personalized treatment approaches.
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