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

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AbbVie Announces Topline Results from Two Phase 3 Studies Investigating Veliparib in Combination with Chemotherapy for the Treatment of Patients with Advanced or Metastatic Squamous Non-Small Cell Lung Cancer and Early-Stage Triple-Negative Breast Cancer

(AbbVie) Apr 19, 2017 - AbbVie, a global biopharmaceutical company, today announced that two Phase 3 studies evaluating veliparib, an investigational, oral poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor did not meet their primary endpoints.

Howard S. Hochster, MD (Posted: April 27, 2017)

quotesIt is not difficult to imagine that PARP inhibitors, which function through the Homologous Repair pathway, would not add much to standard platinum based therapy in unselected lung cancer and TNBC. What is harder to imagine, is what AbbVie would launch phase 3 trials in unselected patient populations who do not have defined DNA repair defects. We can do better in this era of tumor profiling.quotes

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FDA Approves Alunbrig (brigatinib) for Rare Lung Cancer

(Rare Disease Report) Apr 29, 2017 - On Friday evening, Takeda Pharmaceuticals announced the FDA has approved Alunbrig (brigatinib) to treat patients with anaplastic lymphoma kinase-positive (ALK+) metastatic non-small cell lung cancer (NSCLC) who have progressed on or are intolerant to crizotinib.

H. Jack West, MD (Posted: May 01, 2017)

quotesThe data with brigatinib are strong, as this is an agent that has impressive activity against a broad range of secondary mutations in ALK preclinically, and clinically it is the first second generation ALK inhibitor that demonstrates a median progression-free survival beyond one year. Although the various second generation ALK inhibitors have yet to be compared directly to each other, the results with brigatinib are favorable in cross-trial comparisons. It is also typically well tolerated, though the potential for early pulmonary toxicity in the first few days requires attention and some caution (this is the reason for the escalation from 90 to 180 mg daily after one week). But the landscape of ALK-positive advanced NSCLC is about to be transformed with the presentation of the results of the global ALEX trial, expected to be at ASCO. This phase III study of alectinib vs. crizotinib in ALK inhibitor-naive patients was recently noted to be positive for a PFS benefit with alectinib, and if it is even half of the demonstrated PFS benefit demonstrated in the smaller and Japanese-only J-ALEX trial reported at ASCO 2016 (Nokihara, A#9008), it should be enough to change practice and make alectinib the first line therapy of choice for ALK-positive NSCLC. That will leave brigatinib likely relegated to post-alectinib, where it may have far less activity than after crizotinib, since brigatinib and alectinib are both second generation ALK inhibitors and may have significant cross-resistance between them. It's certainly great to have another effective ALK inhibitor available for patients, and we'll need further data to see how brigatinib looks in first line (trial ongoing, vs. crizotinib) as well as its activity after alectinib. We'll also need to keep an eye out for lorlatinib, a third generation ALK inhibitor with activity even after acquired resistance to second generation ALK inhibitor therapy, and other ALK inhibitors in development.quotes

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ELCC 2017 Press Release: Patients With Non-Small-Cell Lung Cancer Respond Best to Salvage Chemotherapy When Pre-Treated With PD-1/PD-L1 Inhibitors

(ESMO) May 4, 2017 - Patients with advanced non-small-cell lung cancer (NSCLC) who require salvage chemotherapy are 30% more likely to achieve a partial response if they have been pre-treated with a PD-1/PD-L1 checkpoint inhibitor compared to those who have not, according to a study to be presented at the European Lung Cancer Conference (ELCC) 2017 in Geneva, Switzerland.

H. Jack West, MD (Posted: May 04, 2017)

quotesThese results are very provocative, but we need a larger, randomized study to say anything more definitive about whether great activity of chemotherapy after rather than preceding immunotherapy is a reason to change how we typically sequence systemic lung cancer therapies. We will see far more studies of immunotherapy in the first line setting over the next few years, and it will be helpful to assess whether this finding is commonly demonstrated.quotes

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Meet the Editorial Board

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

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

Lung Cancer
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H. Jack West, MD

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

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

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Jeff Patton, M.D.

CEO Tennessee Oncology...

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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

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Ted Okon

Executive Director Community Oncology Alliance...

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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

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Winston Wong, PharmD

President, W-Squared Group...