Balazs Halmos, MD, section chief of Thoracic Oncology at New York-Presbyterian Hospital/Columbia University Medical Center, discusses the impact of EGFR inhibitors on the treatment of lung cancer.

It is now widely recognized that a proportion of patients with lung cancer (about 10% in the U.S.) carry an 

 mutation. This discovery has transformed the way the disease is treated.

EGFR inhibitors extend survival and are less toxic than chemotherapies, Halmos saysâ€‹. Previously, life expectancy was 12 months in this population; now, it is about 3 years. EGFR inhibitors have changed the entire mindset of how to treat lung cancer.

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Dr. Halmos on the Impact of EGFR Inhibitors on the Treatment of Lung Cancer

Balazs Halmos, MD, section chief of Thoracic Oncology at New York-Presbyterian Hospital/Columbia University Medical Center, discusses the variety of immune checkpoint inhibitors that are currently being explored as treatments for patients with non-small cell lung cancer (NSCLC).

Currently, Halmos is involved in the investigation of the PD-1 inhibitor MK-3475. In addition to this agent, several other therapies are being explored in NSCLC that target immune checkpoints, including the PD-1 inhibitor nivolumab and the PD-L1 inhibitor MPDL3280A. These agents have been explored primarily in phase I studies. As a result, it remains unclear whether targeting PD-1 or PD-L1 is superior.

When exploring these agents, it is essential to look at the levels of pneumonitis and other side effects to determine the best approach. At this point, it appears that PD-L1 inhibition could result in fewer side effects, like pneumonitis, Halmos believes. Future research in this space will focus on patient selection, minimizing toxicities, and which class of agents is the most effective.

Balazs Halmos, MD, section chief of Thoracic Oncology at New York-Presbyterian Hospital/Columbia University Medical Center, discusses the anti-PD-L1 antibody MK-3475 and the challenge of integrating immunotherapies into the field of lung cancer.

Dr. Halmos on Checkpoint Inhibitors in Lung Cancer

Balazs Halmos, MD, section chief of Thoracic Oncology at NewYork-Presbyterian Hospital/Columbia University Medical Center, discusses the implication of the IPASS study.

The IPASS study was a key study in the field, Halmos says, as it analyzed the EGFR inhibitor gefitinib compared with standard chemotherapy for patients with advanced lung adenocarcinoma without knowledge of EGFR mutation status.

Results of the study showed that the two groups fared similarly over the long term, but that there was a huge discrepancy between outcomes in patients with EGFR mutated and wild-type tumors. Patients treated with gefitinib demonstrated a 70-fold greater benefit in EGFR mutated tumors compared with wild-type. This group of patients also experienced quality of life benefits.

The IPASS study was the first that concluded there was a need to identify patients early on with EGFR mutations and ensure that they receive an upfront EGFR tyrosine kinase inhibitor.

Balazs Halmos, MD

Articles

Dr. Halmos on the Impact of EGFR Inhibitors on the Treatment of Lung Cancer

Dr. Halmos on Checkpoint Inhibitors in Lung Cancer

Dr. Halmos on the Implications of the IPASS Study