, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, 

 covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.

In today’s episode, supported by Real Chemistry, we had the pleasure of speaking with Ravi Salgia, MD, PhD, about the use of tepotinib (Tepmetko) in patients with non–small cell lung cancer (NSCLC) harboring 

 exon 14 skipping mutations. Dr Salgia is a professor and chair of the Department of Medical Oncology & Therapeutics Research, as well as the Arthur & Rosalie Kaplan Chair in Medical Oncology & Therapeutics Research at City of Hope in Duarte, California.

In our exclusive interview, Dr Salgia discussed key updated findings from the phase 2 VISION trial (NCT02864992) investigating tepotinib in patients with NSCLC with 

 exon 14 skipping mutations, results from a real-world analysis comparing tepotinib vs capmatinib (Tabrecta) in patients with stage IV disease, and how he chooses between these 2 agents in the clinic.

That’s all we have for today! Thank you for listening to this episode of 

, supported by Real Chemistry. Check back on Mondays and Thursdays for exclusive interviews with leading experts in the oncology field.

For more updates in oncology, be sure to visit www.OncLive.com and sign up for our e-newsletters.

 is also on social media. On Twitter, follow us at @OncLive. On Facebook, like us at OncLive, and follow our OncLive page on LinkedIn.

, please consider subscribing to our podcast on Apple Podcasts, Spotify, Google Podcasts, Amazon Music, and many of your other favorite podcast platforms,* so you get a notification every time a new episode is posted. While you are there, please take a moment to rate us!

*OncLive On Air is available on: Apple Podcasts, Google Podcasts, Spotify, Amazon Music, Audacy, CastBox, Deezer, iHeart, JioSaavn, Listen Notes, Player FM, Podcast Addict, Podchaser, RadioPublic, and TuneIn.

Podcasts

Dr Salgia discusses how he chooses between tepotinib and capmatinib in patients with stage IV NSCLC harboring MET exon 14 skipping mutations. 

Salgia Summarizes the Benefits of Tepotinib in MET Exon 14–Mutated NSCLC

Ravi Salgia, MD, PhD, medical oncologist, Arthur & Rosalie Kaplan Chair, medical oncology, City of Hope, discusses the 2023 Bridging the Gaps in Lung Cancer meeting, highlighting unmet needs that remain regarding treatment-related toxicities that can arise with commonly used agents in patients with lung cancer.

The assumption that all TKIs are safe is not true, Salgia begins. For instance, EGFR-directed TKIs, such as osimertinib (Tagrisso), are associated with their share of potential adverse effects (AEs), he says. Osimertinib can lead to a rash, diarrhea, alterations in nail beds, and cardiac changes, Salgia emphasizes, noting that these AEs necessitate vigilant monitoring of the heart, liver, and kidneys. Therefore, the assertion that TKIs are universally safe is an oversimplification. When AEs transpire, they significantly impair patients’ quality of life.

Awareness of toxicities is important, as each lung cancer treatment agent is associated withdistinct AEs. For instance, MET inhibitors, such as tepotinib (Tepmetko) and capmatinib (Tabrecta), may trigger general body anasarca or edema in the lower extremities, as well as liver dysfunction, Salgia expands. Thorough monitoring and appropriate management of these AEs are essential in such cases. Moreover, KRAS inhibitors, such as adagrasib (Krazati) and sotorasib (Lumakras), are associated with liver dysfunction, alongside the potential for nausea and vomiting, he emphasizes. Furthermore, the co-administration of KRAS inhibitors and immunotherapy agents amplifies the likelihood of these toxicities.

These targeted drugs, despite their precision, are associated with off-target AEs, necessitating vigilance throughout treatment. Salgia says oncologists are unable to predict which specific AEs a given patient might experience in response to a particular drug. Notably, the toxicities associated with immunotherapy agents can be formidable, ranging from hypophysitis to pneumonitis, colitis, nephritis, and hepatitis. The likelihood of these AEs underscores the need for health care practitioners to remain aware of these potential complications, he concludes.

Videos

Ravi Salgia, MD, PhD, discusses the 2023 Bridging the Gaps in Lung Cancer meeting, highlighting unmet needs that remain regarding treatment-related toxicities that can arise with commonly used agents in patients with lung cancer.

Dr Salgia on Unmet Needs Associated With Treatment-Related Toxicity in Lung Cancer

Ravi Salgia, MD, PhD, medical oncologist, Arthur & Rosalie Kaplan Chair, medical oncology, City of Hope, discusses clinical gaps in the development of novel targets in lung cancer that were discussed at the 2023 Bridging the Gaps in Lung Cancer meeting, as well as potential strategies or steps to address these gaps in clinical practice.

When discussing gaps in care within the lung cancer space, it is important to identify those gaps that may be associated with the development and subsequent utilization of novel targeted therapeutics, Salgia begins. 

With the continuous shift that targeted agents have caused in the treatment of lung cancer patients, , there is now asignificant need to improve navigation of these treatment options and better identify patients who would benefit from these specific therapies, Salgia says. Moreover, any toxicities associated with these regimens should be known and considered during treatment selection, Salgia adds. This underscores the importance of tailoring treatments to maximize benefit and minimize harm, he explains.

Beyond the benefit that a personalized approach provides to treatment selection, there is now a focus on exploring the potential advantages of combining targeted therapies with other treatment modalities, such as chemotherapy, Salgia continues. This raises questions concerning the viability of extending these therapies to patients with early-stage disease and ensuring their effectiveness in diverse patient populations, he states.

Reducing the toxicity of treatments is one method by which to potentially address gaps in the treatment of patients with lung cancer, Salgia says. This could be accomplished by conducting more trials and involving a broader range of patients in research endeavors, he expands. This may yield greater insights into the development of novel therapies that are both effective and well-tolerated, Salgia explains.

Lastly, the economic burden placed on patients due to the high cost of cancer treatments is another pressing issue, Salgia notes. Collaborative efforts among institutions to lower the cost of these agents are crucial for reducing financial toxicities, thereby ensuring that patients receive optimal care without suffering undue financial strain, Salgia states.

Although these are general solutions, they are essential to improving outcomes in clinical practice, Salgia concludes. The pursuit of less toxic treatments, personalized drug selection, and cost-effective strategies will not only benefit patients but may also advance the treatment paradigm in lung cancer.

Ravi Salgia, MD, PhD, discusses clinical gaps in the development of novel targets in lung cancer that were discussed at the 2023 Bridging the Gaps in Lung Cancer meeting, as well as potential strategies or steps to address these gaps in clinical practice.

Dr Salgia on Clinical Gaps in the Development of Novel Targets in Lung Cancer

Ravi Salgia, MD, PhD, Arthur & Rosalie Kaplan Chair in Medical Oncology, associate director for clinical sciences at City of Hope, discusses the FDA approval of lorlatinib for use in patients with 

-positive metastatic non—small cell lung cancer (NSCLC).

Ravi Salgia, MD, PhD, Arthur & Rosalie Kaplan Chair in Medical Oncology, associate director for clinical sciences at City of Hope, discusses the FDA approval of lorlatinib for use in patients with ALK-positive metastatic non–small cell lung cancer.

Dr. Salgia on FDA Approval of Lorlatinib in ALK+ NSCLC

Ravi Salgia, MD, PhD, associate director, Clinical Sciences Research, Arthur & Rosalie Kaplan Chair, Medical Oncology, professor and chair, Department of Medical Oncology & Therapeutics Research, City of Hope, discusses effective agents in the treatment of patients with 

The phase I clinical trial that investigated crizotinib (Xalkori) was initially designed to examine the compound as a MET inhibitor. Investigators later realized that it was also an effective ALK inhibitor, Salgia says. The drug was later approved by the FDA because of its durable progression-free survival in third-line, fourth-line, and fifth-line therapies.

There are other tyrosine-kinase inhibitors for 

-positive patients, such as ceritinib (Zykadia), brigatinib (Alunbrig), and alectinib (Alecensa). Now, researchers are looking at how to optimally sequence these agents.

Ravi Salgia, MD, PhD, associate director, Clinical Sciences Research, Arthur & Rosalie Kaplan Chair, Medical Oncology, professor and chair, Department of Medical Oncology & Therapeutics Research, City of Hope, discusses effective agents in the treatment of patients with ALK-positive tumors.

Dr. Salgia on Crizotinib and Other TKIs in ALK-Positive NSCLC

Ravi Salgia, MD, PhD, Arthur & Rosalie Kaplan Chair in Medical Oncology, associate director for clinical sciences at City of Hope, discusses the importance of molecular markers in lung cancer.

Lung cancer can be subdivided into histology subtypes, like non-small cell lung cancer (NSCLC) and small cell lung cancer. There are also adenocarcinomas, nonsquamous cell carcinomas, squamous cell carcinomas, and sometimes large cell carcinomas, but there are also subsets in terms of molecular markers, Salgia adds. There are 

 translocations, which can be discovered through a molecular test.

Salgia says that molecular testing is imperative and standard. Molecular testing can indicate a targetable pathway for a patient, and can open up additional treatment options if the patient harbors a particular mutation. As a standard practice in NSCLC, molecular testing has transformed therapeutic approaches and sequencing for patients.

Dr. Salgia on Importance of Molecular Markers in Lung Cancer

Ravi Salgia, MD, PhD, Arthur & Rosalie Kaplan Chair in Medical Oncology, associate director for clinical sciences at City of Hope, discusses the importance of next-generation sequencing for patients with lung cancer.

Next-generation sequencing can detect mutations, translocations, and amplifications, explains Salgia. The FDA has just approved one of the tests. It is important for the test to be in the tumor tissue, but there might not be enough tissue in the lung. If there is not enough tumor tissue, a liquid biopsy is a possible alternative, according to Salgia.

Ravi Salgia, MD, PhD

Articles