OBR Daily Commentary - Lung (includes NSCLC, SCLC, Mesothelioma)

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Broad Genetic Testing For Advanced Lung Cancer May Not Improve Survival

(Yale News) Aug 7, 2018 - Testing for dozens of genetic mutations in tumors of patients with a common form of advanced lung cancer did not appear to improve survival compared to routine genetic testing, a study led by Yale Cancer Center (YCC) scientists has found. The research was published in JAMA. Broad-based genomic sequencing (BGS) evaluates numerous genes to identify mutations in tumors of patients with advanced non-small cell lung cancer. If a mutation is found and a drug exists to target the mutation, BGS can help clinicians personalize and treat the disease. However, questions remain about how broad-based testing, which can be costly, compares to more routine testing that focuses on one or two established, treatable genetic mutations. Researchers analyzed data from Flatiron Health of more than 5,000 patients with advanced non-small cell lung cancer that were treated in a community oncology clinic. The researchers identified patients who received either BGS testing, or routine testing for alterations in two specific genes, EGFR or ALK. They determined how frequently the BGS testing identified specific mutations that guided the choice of therapy and compared overall survival rates for the patients receiving BGS with those receiving routine testing.

H. Jack West, MD (Posted: August 08, 2018)

quotesThis doesn't mean that NGS testing is useless, but we must be careful not to oversell it as a miracle. It actually helps relatively few patients beyond standard, limited testing right now, with no improvement in survival in population-based evaluation, at least corrected for other variables. However, it is a more tissue-efficient way to test for 4-5 or more markers, as we should now be doing for non-squamous NSCLC, and the value of NGS is likely to be a moving target only rising over time. My conclusion is that we should stop over-promising what precision oncology will deliver, but we also shouldn't throw out the baby with the bathwater.quotes

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Takeda Announces Phase 3 Trial of ALUNBRIG® (brigatinib) Met Primary Endpoint Demonstrating Superiority in Progression-Free Survival Versus Crizotinib in Patients with ALK+ Advanced NSCLC Who are ALK Inhibitor Naïve

(Morningstar) July 25, 2018 - Takeda Pharmaceutical Company Limited today announced that the global, randomized, Phase 3 ALTA-1L (ALK in Lung Cancer Trial of AP26113 in 1 st Line) trial met its primary endpoint at the first pre-specified interim analysis, with ALUNBRIG® (brigatinib) demonstrating a statistically significant improvement in progression-free survival (PFS) compared to crizotinib in adults with anaplastic lymphoma kinase-positive (ALK+) locally advanced or metastatic non-small cell lung cancer (NSCLC) who had not received a prior ALK inhibitor. The trial was designed to assess the efficacy and safety of ALUNBRIG in comparison to crizotinib based on evaluation of the primary endpoint of PFS, or length of time from the start of treatment that a patient lives without the disease getting worse. ALUNBRIG is currently not approved as frontline therapy. “This represents a major milestone for the ALUNBRIG program. Our goal with ALUNBRIG is to improve the lives of patients with ALK+ NSCLC by furthering the available therapeutic options,” said Jesús Gomez-Navarro, M.D., Vice President, Head of Oncology Clinical Research and Development, Takeda.

H. Jack West, MD (Posted: July 25, 2018)

quotesNice to see, though not surprising. Brigatinib is a very good second generation ALK inhibitor, at least comparable to if not more efficacious than alectinib, which crushed crizotinib in the ALEX trial that was a head to head comparison of the two. The real question is whether brigatinib will look like a lateral move or possibly meaningfully better than alectinib when we're left to do our cross-trial comparison of ALTA-1 results to those from ALEX. We'll look forward to seeing the actual results in one of the fall meetings -- not sure if that will be WCLC in Toronto or at ESMO in Munich.quotes

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Complementary Medicine For Cancer Can Decrease Survival

(Yale News) July 19, 2018 - People who received complementary therapy for curable cancers were more likely to refuse at least one component of their conventional cancer treatment, and were more likely to die as a result, according to researchers from Yale Cancer Center and the Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER) at Yale School of Medicine. The findings were reported today online in JAMA Oncology. Use of complementary medicine — medical therapies that fall beyond the scope of scientific medicine — is growing in the United States and often used by patients with cancer.

H. Jack West, MD (Posted: July 20, 2018)

quotesVery unfortunate and very believable. Some proponents of complementary medicine note that "complementary" is intended to mean that these treatments are given alongside conventional therapies, rather than instead of them, as "alternative" medicines will be. Nevertheless, this work strongly indicts treatment philosophies that are not grounded in clinical evidence and shows that they clearly subtract more than they add for patients with treatable cancers, who are all too often presume that the "medicine" in complementary medicine is actually effective. That is the greater misnomer here, and it leads to net harm to the people gullible enough to pursue it.quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

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Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

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Howard S. Hochster, MD

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