Lingering Unknowns Amid Lung Cancer Breakthroughs: Martin Edelman, MD

With over 3 decades of experience in oncology, Martin Edelman, MD, FACP, associate director, clinical research integration, Fox Chase Cancer Center, has witnessed dramatic growth in lung cancer research, interventions, and patient outcomes. In this interview with The American Journal of Managed Care^®, Edelman spoke more to the progress he’s witnessed in this field, while drawing attention to some of the pertinent challenges clinicians and researchers still face.

In particular, Edelman touched on the implications that mutations, such as with estimated glomerular filtration rate (EGFR), PD-L1, anaplastic lymphoma kinase (ALK), and others, have on treatment approaches. Although clinical understandings of these mutations has grown immensely, he mentioned, it often remains unclear how the presence of these mutations will impact a patient’s response to a given treatment.

These topics, the influence of value-based care models in oncology, and more, were explored at a recent Institute for Value-Based Medicine^® event held in Philadelphia, Pennsylvania.

This transcript has been lightly edited; captions were auto-generated.

Transcript

With the increasing use of biomarker-driven therapies and immunotherapies in lung cancer, can you speak to any recent care innovations you believe have been the most impactful?

How do I put it? They've all been dramatic changes. I've been doing oncology for 30-35 years, and nothing has changed so dramatically as the treatment landscape for lung cancer. The earliest things were the impact of the targeted drugs, particularly in EGFR-mutated disease, which turned that into, for many patients, into a long-term disease, and for others, certainly extended life. Clearly, immunotherapy has had a very dramatic impact, with, dare I say it, some patients with advanced lung cancer now being cured of their disease, something most of us never thought would happen.

The problem is that we can't easily predict the beneficiaries for these treatments. We have some idea with specific mutations—we know that drugs won't work if the mutation is not present. The problem is, for those who do have a mutation, we're not always sure how durable their response will be. We're beginning to get some hints of this based upon both clinical as well as laboratory data, presence of comutations, but still pretty inexact. And that alters the choice of treatments as we go forward, with some advocating the addition of chemotherapy to targeted therapies for those with more complex situations. For immunotherapy, PD-L1 is helpful. But there are patients who will not do well despite high PD-L1, and then there are those who do well with a low PD-L1.

We are increasingly finding that the presence of comutations is of importance in deciding this above and beyond the fact that those with EGFR, ALK, and some of the other driver mutations do not benefit from immunotherapy. It's an area of great improvement, but still a long way to go, and very complex, and a growingly increasingly more complex field.