For Treatment Resistance in NSCLC, Repeat Biomarker Testing Is Key, Says Dr Mark Socinski

Mark A. Socinski, MD, executive director of AdventHealth Cancer Institute, gave insight into treatment resistance and the importance of repeat biomarker testing at the time of disease progression in non–small cell lung cancer (NSCLC).

Transcript

How do you approach the issue of drug resistance in patients with NSCLC in your clinical practice?

We've developed a whole new generation of first-line drugs that are highly effective—but, particularly in the arena of targeted therapies, we know that at some point, acquired resistance is going to happen. Again, there are increasing amounts of information about acquired resistance patterns, some of which do have targetable options with it. The best example is in the EGFR mutation–positive space. Using osimertinib, one of the more common acquired resistance mechanisms is MET amplification. We do have a couple of MET drugs that are FDA approved; we have a couple of early studies that look at binding the MET inhibitors with osimertinib in patients who have MET amplification. And you do see clinical benefit there.

We also know that there are other bypass tracks that may happen that may have a targeted therapy. So I think the approach to the resistance issue is the concept of retesting at the time of progression, so that you can understand if there is an acquired resistance mechanism that might have a targeted therapy associated with it. Oftentimes, you won't find something like that. But I think the message of dealing with resistance is retesting to see what may be there. Can you identify a mechanism of acquired resistance that may have a different treatment option for the patient? So I think the take home message with regard to the resistance issue is retesting.