Dr Liu on the Importance of NGS Testing in NSCLC

Stephen V. Liu, MD, associate professor of medicine, Georgetown University, director, Thoracic Oncology, head, Developmental Therapeutics, Georgetown Lombardi Comprehensive Cancer Center, discusses the importance of next-generation sequencing in non–small cell lung cancer, and details trials that have continued to move this treatment arena forward.

At a recent OncLive State of the Science Summit™ on lung cancer, investigators addressed the evolving role of immunotherapy in resectable NSCLC seen in studies such as the phase 3 IMpower010 trial (NCT02486718) and the phase 3 PEARLS/KEYNOTE-091 study (NCT02504372), investigating adjuvant immunotherapy in the form of either a PD-1/PD-L1 inhibitor, Liu begins. Additionally, the phase 3 CheckMate 816 study (NCT02998528) investigates neoadjuvant immunotherapy combined with chemotherapy, Liu explains.

These approaches have elicited beneficial improvement with the addition of immunotherapy around the time of surgery in the form of pathologic complete responses, durable responses, and impressive event-free survival data, Liu expands. However, it remains important to deliver these treatments to the most-likely-to-benefit patient population, he emphasizes.

Investigators are evaluating markers of responses, such as PD-L1 expression, as well as markers that predict lack of response, Liu says. For example, patients whose tumor harbors a sensitizing EGFR mutation would not benefit from immunotherapy and can be better served with more targeted treatment options. The phase 3 ADAURA study (NCT02511106) demonstrated that treating adjuvant osimertinib (Tagrisso) in EGFR-mutant NSCLC improves disease-free survival and helps to reduce the risk of prevents brain metastasis spread of cancer to the brain, Liu adds. Again, it remains important to be able to identify these patients best suited for such treatment.

If a patient has already undergone surgery though, there is time to do sequencing to get full panels back. The challenge presents itself in that neoadjuvant setting due to the need for biomarker results before the start of immunotherapy, Liu continues. Therefore, this emphasizes the need for next-generation sequencing, Liu concludes.