Thomas Stricker, MD, PhD, speaks with the Journal of Clinical Pathways about his research on the clinical impact of the timing of first line targeted therapy in aNSCLC patients with actionable driver oncogenes.

Transcript:

Dr Thomas Stricker: I'm Dr. Thomas Stricker. I am the medical director for Precision Medicine at OneOncology, as well as the technical director of the genomics lab at Tennessee Oncology.

Can you give some background about your study and what prompted you to undertake it?

Dr Stricker: We know that timely testing for targeted therapy and advanced non-small cell lung cancer is critical. And we also know that up to 27% of patients in a recent study did not receive targeted therapy, even though they had a test indicating that they have a mutation that would respond to such therapy. And so there's a data gap in understanding when the proper time to switch patients to targeted therapy, if they've started a non-targeted therapy, it would be appropriate and there can be delays in testing. And so it is not uncommon to get results back perhaps after therapy has been initiated. And so we wanted to explore what happens to patients who switch early versus patients who switch late. And so that was the point of our study.

Can you briefly describe how the study was conducted?

Dr Stricker: We used the Flatiron Real-World database and it was a retrospective study of patients with advanced non-small cell lung cancer in that database from 2015 to 2022.

What were the key findings of your study?

Dr Stricker: We found that patients who switched early, so that's within 42 days of starting a non targeted therapy. If they had a targeted mutation and we switched them to a targeted therapy that their outcomes were similar to patients who started a targeted therapy at the outset. However, patients who delayed switching until progression, so generally after 84 days or more, had an outcome that was not as good as patients who switched. And so if you have a patient who you have started on chemo and you get a result back indicating that they have a targetable therapy, switching them early can lead to similar outcomes as if you'd started them on a drug to begin with.

Looking ahead, what potential impact do you hope your findings will have on improving timely treatment options?

Dr Stricker: Ideally we'll improve turnaround times and everyone will just start on the drug initially. That's where we'd definitely like to get to, but I think what's important here is to understand that if you get a test result back having started a non-targeted therapy, that all hope is not lost. That you can still have a lot of benefit by switching that patient early and so that we can still get patients on the therapy they need at the right time.

Is there anything else you'd like to add?

Dr Stricker: I think I'm heartened that this turns out to be true, that early switching has a benefit to patients and hopefully that will help patient outcomes.