Jonathan W. Goldman, MD, hematologist and oncologist, UCLA Medical Center, discusses key takeaways from the phase 3 CASPIAN trial (NCT03043872) in patients with extensive-stage small cell lung cancer (ES-SCLC).

CASPIAN examined the use of durvalumab (Imfinzi) in combination with etoposide and either carboplatin or cisplatin, or durvalumab and chemotherapy with the addition of tremelimumab vs chemotherapy alone in the frontline treatment of patients with ES-SCLC.

Results from the study showed no overall survival benefit with the 4-drug regimen. However, a median OS benefit of approximately 2.5 months was observed with the 3-drug regimen vs chemotherapy alone, translating to a hazard ratio of 0.75. The regimens were also found to have favorable safety profiles, according to Goldman. The addition of immunotherapy to the chemotherapy backbone did not come at the cost of significant toxicity.

Some immunotherapy-related toxicities were observed in the durvalumab arm, but most were manageable endocrine disorders, Goldman says. The OS data, along with the quality-of-life benefit of delayed worsening of symptoms, support durvalumab plus chemotherapy as a standard-of-care treatment in the first-line setting for this population, Goldman concludes.

Videos

Jonathan W. Goldman, MD, discusses key takeaways from the phase 3 CASPIAN trial in patients with extensive-stage small cell lung cancer.


Dr. Goldman on Key Takeaways From the CASPIAN Trial in Frontline ES-SCLC

Jonathan W. Goldman, MD, health sciences clinical instructor, Department of Medicine, and Hematology/Oncology member, Jonsson Comprehensive Cancer Center Signal Transduction and Therapeutics Program, UCLA, discusses the use of immunotherapy in patients with oncogene-driven non—small cell lung cancer (NSCLC).

Immunotherapy, either alone or in combination with chemotherapy, plays an important role in the treatment of patients with advanced nonsquamous and squamous NSCLC. However, the role of immunotherapy in oncogene-driven cancers, such as 

, is less apparent. While the benefit of immunotherapy alone in these subsets is limited, there may be benefit to chemoimmunotherapy for patients whose tumors harbor 

According to data from the phase III IMpower150 trial, a small subset of patients with

 fusions derived benefit from the addition of atezolizumab (Tecentriq) to carboplatin, paclitaxel, and bevacizumab (Avastin). Although the trial wasn’t powered to evaluate benefit in this population, there is enough evidence to consider it as an option after patients with these alterations have progressed through all available targeted therapies, concludes Goldman.

Jonathan W. Goldman, MD, health sciences clinical instructor, Department of Medicine, and Hematology/Oncology member, Jonsson Comprehensive Cancer Center Signal Transduction and Therapeutics Program, UCLA, discusses the use of immunotherapy in patients with oncogene-driven non–small cell lung cancer (NSCLC).

Dr. Goldman on the Use of Immunotherapy in Oncogene-Driven NSCLC

Jonathan W. Goldman, MD, health sciences clinical instructor, Department of Medicine, and Hematology/Oncology member, Jonsson Comprehensive Cancer Center Signal Transduction and Therapeutics Program, UCLA, discusses the impact of liquid biopsies in lung cancer.

Liquid biopsies have reduced the amount of time it takes to perform a biopsy and match patients with appropriate therapy, explains Goldman. If patients don't have tissue results when they come in for their initial evaluation, a blood test can provide potentially actionable results within a week. Additionally, blood tests are performed with next-generation sequencing, which accounts for 70 or more mutations at a time.

Currently, liquid biopsies are not as sensitive as standard tissue tests, says Goldman. While there is concern for false negatives with liquid biopsies, a positive result is a dependable result. Apart from diagnosis, liquid biopsies could also be used to assess resistance mutations, concludes Goldman.

Jonathan W. Goldman, discusses the impact of liquid biopsies in lung cancer.

Dr. Goldman on the Impact of Liquid Biopsies in Lung Cancer

Jonathan W. Goldman, MD, health sciences clinical instructor, Department of Medicine, and Hematology/Oncology member, Jonsson Comprehensive Cancer Center Signal Transduction and Therapeutics Program, UCLA, discusses targeted therapy options for patients with 

-mutated non—small cell lung cancer (NSCLC).

In April 2018, osimertinib (Tagrisso) was approved by the FDA for the first-line treatment of patients with metastatic NSCLC whose tumors harbor 

 exon 19 deletions or exon 21 L858R mutations.

Osimertinib is a highly effective oral TKI with limited adverse events, explains Goldman.

Similarly, alectinib (Alecensa) is a well-tolerated oral TKI that was approved by the FDA in November 2017 for the treatment of patients with 

Patients treated with alectinib can experience durable remissions, says Goldman.

 mutations are relatively rare, 2 oral inhibitors, crizotinib (Xalkori) and entrectinib (Rozlytrek), have been approved for the treatment of patients with 

Jonathan W. Goldman, MD, discusses targeted therapy options for patients with EGFR-, ALK-, and ROS1-mutated non–small cell lung cancer.

Jonathan W. Goldman, MD

Articles

Dr. Goldman on Key Takeaways From the CASPIAN Trial in Frontline ES-SCLC

Dr. Goldman on the Use of Immunotherapy in Oncogene-Driven NSCLC

Dr. Goldman on the Impact of Liquid Biopsies in Lung Cancer

Dr. Goldman on Targeted Therapy Options for EGFR-, ALK-, and ROS1-Mutated NSCLC