Dr Singhi on Areas of Interest in Metastatic Lung Cancer Research

Eric Kumar Singhi, MD, assistant professor, Department of General Oncology, Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses potential areas of research interest in the treatment of patients with metastatic lung cancer.

A critical area of focus for patients with metastatic lung cancer is determining the next steps after progression on immunotherapy, specifically in the second-line setting, Singhi begins. Currently, docetaxel remains the standard of care (SOC) in this scenario, and challenges have arisen when trying to develop investigational treatments that outperform this drug, he explains. Recently, there has been significant interest in the development of antibody-drug conjugates (ADCs) for this purpose, according to Singhi. During the 2024 ASCO Annual Meeting, data from the phase 3 EVOKE-01 study (NCT05089734)—a trial examining the TROP2-directed ADC sacituzumab govitecan-hziy (Trodelvy) in patients with metastatic non–small cell lung cancer (NSCLC)—were presented. This trial compared sacituzumab govitecan with docetaxel in patients who had progressed following chemoradiotherapy, Singhi states. Although the trial did not meet its primary end point of overall survival, it showed a numerical improvement with sacituzumab govitecan vs docetaxel in patients who had not responded to prior immunotherapy.

This finding raises the question of whether oncologists are still in the process of identifying the ideal patient population for ADCs or whether additional biomarkers are needed to guide treatment decisions, he continues. Despite the excitement surrounding these emerging ADCs, they have yet to deliver a breakthrough response for patients in the second-line setting and beyond after progression on chemoimmunotherapy, Singhi emphasizes, adding that this indicates a need to explore alternative strategies.

One trial generating considerable anticipation is the phase 3 Pragmatica-Lung study (NCT05633602) comparing ramucirumab (Cyramza) plus pembrolizumab (Keytruda) with SOC treatments for patients with recurrent NSCLCafter immunotherapy, he explains. The potential for a response to immunotherapy with the addition of ramucirumab appears promising, and the results are eagerly awaited, Singhi concludes.