Tumor Agnostic Therapies for Patients With Solid Tumors
Vivek Subbiah, MD, Sarah Cannon Research Institute, Nashville, Tennessee, discusses advances in tumor agnostic therapies and explores how these therapies can shift the treatment landscape for patients with solid tumors.
Transcript:
Hi, I'm Vivek Subbiah, from Sarah Cannon Research Institute, Nashville, Tennessee. It's great to see you all at the Great Debates in oncology in New York. Again, thank you so much for having me on primetime Sunday for this plenary session.
Today, I gave this talk on tumor agnostic therapies, revolutionizing cancer therapies from target specific to tumor agnostic. Again, what are tumor agnostic therapies? Tumor agnostic therapies are a different way we think about cancers. It's thinking about the target, not the tumor. I personally feel that the way in which our tumor treatments have developed, we are denying and delaying access to many patients with rare cancers to targeted therapies, immunotherapies, and many therapies that they would benefit for. Why do I say that? Because we are used to making drugs for lung cancer, kidney cancer, prostate cancer, breast cancer, but a tumor agnostic therapy is a different way we think about cancers — it is thinking about the target, thinking about the underlying biomarker, and not about the tumor type.
May 2017 was a watershed moment in oncology. Why? Because pembrolizumab was approved in a tumor agnostic manner across all solid tumors harboring the microsatellite instability high cancer or dMMR [mismatch repair deficient]-positive cancers. Again, why do I say it's a watershed moment? Because for the first time, a drug was approved based on a biomarker, not based on a tumor type.
From May 2017 to date, we have at least 10 drugs approved in a tumor agnostic space. We have 3 drugs, not 1, not 2, but 3 drugs as NTRK inhibitors approved for NTRK fusion positive cancers. As you all know, NTRK is seen across tumor types. NTRK fusions are picking needles in haystacks, it is less than 1% across many, many tumor types. We have 3 drugs, larotrectinib, entrectinib, and repotrectinib approved in all NTRK fusion positive cancers. Subsequently, we had pembrolizumab, again, the immunotherapy approved for all tumor mutation burden high > 10 positive cancers. Another immune checkpoint inhibitor called dostarlimab was, once again, approved for dMMR-positive solid tumors. Then dabrafenib and trametinib, a BRAF and MEK inhibitor, was approved for BRAF V600 positive solid tumors. Then selpercatinib, a selective RET inhibitor was approved for RET fusion positive solid tumors. Subsequently, the first ever antibody drug conjugate, trastuzumab deruxtecan was approved across all IHC3+ positive cancers. Again, this was the first time an antibody drug conjugate received a tissue agnostic approval. More recently, we had repotrectinib, the third NTRK drug being approved for NTRK fusion positive solid cancers.
As of today, we have around 10 drugs approved in a tumor agnostic manner. In order for our patients to benefit from these therapies, we need to test them with a comprehensive genomic testing and immunohistochemistry for HER2/IHC3, so that we can benefit the right patient in the right clinic at the right time, which is a central mantra of precision medicine and our goal of precision oncology.
Source:
Subbiah V. Plenary: Tumor Agnostic Therapies - Revolutionizing Cancer Treatment: From Tissue-Specific to Target-Driven. Presented at Great Debates in Solid Tumors. March 22-23, 2025; New York, NY.
