Transcript

I'm David Carbone. I'm a thoracic medical oncologist and the Director of the Thoracic Oncology Center at Ohio State University in Columbus, Ohio. I would like to talk today a little bit about some of the recent progress in lung cancer.

There's been a huge amount of progress in the last decade or 2 in lung cancer, and then it just seems like in the last year there are have been multiple new approvals for lung cancer for both immunotherapies, but also the targeted therapies.

There have been approvals for new targets such as MEK and RET, and those have been major advances in those diseases.

And we have the luxury of having multiple drugs in this space targeting ALK fusion-positive tumors. They've shown very high efficacy, but they're not perfect in that patients with ALK fusion-positive disease still progress and die of their disease eventually.

I've selected a few of the abstracts from ASCO to touch on in this discussion. I think the first abstract I'd like to talk about is an abstract from the Samsung Medical Center. The first author is Kwon. The abstract number or the poster number is 18-4852.

This poster talks about longitudinal monitoring of cell-free DNA in ALK-rearranged lung cancer. But I think that has become kind of the de facto standard for how to track the efficacy of treatment, but also, the acquisition of resistance mutations.

In this poster, they show a group of 92 patients that were tracked longitudinally with different ALK rearrangements, different co-mutations, and they looked at ctDNA after 2 months and at progression and they found about half the patients at progression, or more than half, had acquired ALK-resistance mutations.

The de facto standard for first-line therapy now for ALK is obviously alectinib. But if you can detect specific acquired resistance mutations, you can have efficacy with switching drugs to a different drug.

For example, I have a patient that had a resistance mutation develop on alectinib. He had multiple brain recurrences. I switched him to lorlatinib, and he had a beautiful response, so I think that that's a technology that you should consider implementing.