Multidisciplinary Care, Approval Updates, and Future Research in NSCLC

As part of an Around the Practice program, CancerNetwork® spoke with Misako Nagasaka, MD, PhD, about her current treatment strategies for patients with lung cancer as well as relevant updates and potential advancements in the non–small cell lung cancer (NSCLC) space.

Nagasaka, a thoracic oncologist and associate clinical professor at the University of California, Irvine, discussed sequencing immunotherapy and chemotherapeutic agents depending on factors including EGFR and ALK mutations as well as a patient’s PD-L1 status. She also spoke to the importance of multidisciplinary collaboration at her practice with pulmonologists and surgeons for treating patients in the neoadjuvant and adjuvant settings.

Following the FDA approval of pembrolizumab (Keytruda) plus chemotherapyfor patients with resectable NSCLC in October 2023, Nagasaka stated that she was excited to treat those who may benefit from this regimen. The regulatory agency based its approval on data from the phase 3 KEYNOTE-671 trial (NCT03425643), which assessed the regimen among 797 patients with resectable stage II, IIIA, or IIB NSCLC. 

The median overall survival was not reached (NR; 95% CI, NR-NR) among patients receiving pembrolizumab compared with 52.4 months in those receiving placebo (95% CI, 45.7-NE; HR, 0.72; 95% CI, 0.56-0.93; P = .0103). Additionally, the median event-free survival was NR (95% CI, 34.1 months to NE) vs 17.0 months (95% CI, 14.3-22.0) in each respective arm (HR, 0.58; 95% CI, 0.46-0.72; P <.0001).

Looking ahead at ongoing research efforts, Nagasaka said that her institution is assessing how the gut microbiome may influence a patient responds to treatment, as well as any adverse effects [AEs] they may experience during therapy. Additionally, she spoke about the initiation of the phase 2 PALOMA-2 trial (NCT05498428), which will evaluate amivantamab-vmjw (Rybrevant) administered subcutaneously to those with advanced or metastatic solid tumors, including a population of patients with NSCLC harboring EGFR mutations.

“I’m very excited [to initiate the PALOMA-2 trial] because from preliminary data that I’ve seen, [AE] rates are decreased. That’s really important for patients,” Nagasaka said.