Treatment-Specific Biomarkers, Future of Research for Lung Cancer with Jonathan Spicer, MD, PhD

During this segment of February’s Lungcast episode with Jonathan Spicer, MD, PhD, in their discussion of neoadjuvant, adjuvant, and perioperative therapies for lung cancer, Spicer also touched upon several other notable topics related to lung cancer therapy.

Spicer, medical director of the McGill Thoracic Oncology Program and the principal investigator for the McGill Thoracic Surgery & Upper Gastrointestinal Cancer Research Laboratories, was asked both about treatment-specific biomarkers for lung cancer and about short-term future of lung cancer therapy by Lungcast host Albert Rizzo, MD. Rizzo is the chief medical officer of the American Lung Association (ALA).

Rizzo noted that many lung cancer patients have their biomarkers done to direct their initial therapy. He added that there are around 11 specific targeted mutations with specific therapy recommendations, asking Spider to the significance of these biomarkers.

“This is really a critical thing, because this concept of reflex testing or these assays, this molecular biological characterization of the tumor being done automatically, once a biopsy is generated, it's just not pervasive worldwide,” Spicer said. “...There's a paper that came out from the metastatic setting that was retrospective, but it did show that patients who had next generation sequencing and molecular data prior to initiation of their systemic therapy had better overall survival than those who did not have that information available.”

Spicer explained that this made sense, as not all lung cancers will respond to the same types of treatments.

“I always tried to explain to the patient that I understand the urgency to get to treatment, but the real urgency is to get to the right treatment,” Spicer said. “And that time spent to get the necessary information to adjudicate the correct treatment is vitally important. In the early stage, we've talked about immunotherapy as this new and exciting option that improves survival. But it's not the only innovation.”

Spicer cited examples such as the ADAURA trial, in which the opportunity came about for patients to get post-operative, targeted therapy in the context of lung cancers with mutations in the EGFR gene. Spicer explained that this is associated with an important overall survival benefit.

Rizzo later asked Spicer where he, as a surgeon, thinks lung cancer therapy is going, as well as what he expects or hopes to see.

“Like we've said, it's super exciting for us as clinicians to see all these opportunities emerge,” Spicer said. “For patients, it's just as distressing as ever to receive the diagnosis and have to deal with all of the unknowns. Where are we going? We're just heading into a cloud of complexity, where we have a ton of options that will emerge. We have the challenge of lung cancer becoming 1 of the most commonly diagnosed cancers…and getting appropriate comparisons of the available therapeutic options in each of those distinct biological categories is going to be a massive challenge to do and will require global cooperation.”

Spicer added that what he finds most exciting is what has emerged from some of the trials discussed previously.

“When a patient gets a complete pathological response to chemo immunotherapy, in their overall survival…95% of them are alive,” Spicer said. “So if you apply the right systemic treatment, and you're able to eradicate the cancer with that, and for now we still need to confirm with surgery, that is extremely good news for the patient. It can de-escalate the surveillance to some extent and reassures them that they're not living with a blade over their head that the cancer is going to come back, because the statistics are so promising.”

Check out the segment above to learn more, or listen to the podcast version linked below.

Lungcast is a monthly respiratory health podcast series from the ALA produced by HCPLive.

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