Targeted lung cancer treatment: interview with world-renowned expert
Targeted therapy is a new development in oncology, which attacks cancer cells but does less damage to normal cells.
Professor Tony Mok, a member of the CareAcross Scientific Committee, is an expert in targeted treatments for lung cancer. In this article, he answers 4 important questions relevant to anyone affected by lung cancer.
Interview with Tony Mok: Targeted therapy for lung cancer
CareAcross: Professor Mok, you are a leader in research and treatment of patients with lung cancer adenocarcinoma using targeted therapy. Do you suggest that everyone with this type of cancer must be examined for the possibility to receive such a treatment?
Professor Mok: It is not just me. Recommendation for routine screening for EGFR mutation and ALK rearrangement for all patients with adenocarcinoma irrespective of gender, ethnicity and smoking status is also supported by the scientific guidelines from the following leading healthcare organizations:
- CAP: College of American Pathologists
- IASLC: International Association for the Study of Lung Cancer
- AMP: Association for Molecular Pathology.
CareAcross: Do you feel that patients who carry the EGFR mutation live longer and better?
Professor Mok: When you look at the overall survival data from the 8 randomized studies that compare first line treatment with EGFR tyrosine kinase inhibitor (TKI) versus chemotherapy, you will note that the median Overall Survival ranges from 20 to 32 months. This is definitely longer than what was previously reported in patients with stage IV non-small cell lung cancer.
On the other hand, we must also note that the median age is younger and the majority of patients in these studies are non-smokers.
CareAcross: Is this benefit due to the activity of the targeted drugs against the EGFR mutation, or does this type of adenocarcinoma behave differently?
Professor Mok: I have no doubt that EGFR tyrosine kinase inhibitor (TKI) contributes to the improvement of overall survival of patients with EGFR mutation. Over 70% of patients with EGFR mutation would have rapid and durable response to TKI.
Median progression free survival is 10 to 13 months as per the Response Evaluation Criteria in Solid Tumors, and if we allow treatment beyond progress, patient would have added another 3 months to it (as per the study known as “ASPIRATION”).
Also, in the OPTIMAL study, a subgroup of patients with positive EGFR mutation received first line chemotherapy and never received EGFR TKI, and their median progression free survival was less than 12 months.
Thus, there is little doubt that EGFR TKI adds to the duration of survival.
CareAcross: Following treatment against EGFR mutation, if the disease appears active again, what do you suggest as the next treatment option?
Professor Mok: Resistance to tyrosine-kinase inhibitor (TKI) treatment is a universal phenomenon. For patients with oligoprogression*, local therapy with continuation of TKI is acceptable.
The standard treatment for systemic progression is platinum-based doublet chemotherapy and without continuation of TKI (as per the IMPRESS study). However, new exciting development on drugs targeting the “T790M” mutation (including agents identified as AZ9291 and CO1686) hold promises for future biomarker selection for acquired TKI resistant tumor.
* Note: Oligoprogression is the emergence of ≤5 sites of disease outside the central nervous system.
About Professor Tony Mok
Professor Tony Mok is the President of the most important lung cancer organization, called “International Association for the Study of Lung Cancer” (IASLC). He has been very active in clinical oncology as well as laboratory research, and has contributed to more than 140 articles in scientific journals and book chapters.
Dr Mok is Professor in the Department of Clinical Oncology at the Chinese University of Hong Kong.
He has been a member of the CareAcross Scientific Committee since 2014.