Dr. Wakelee Discusses Current State of Treatment in NSCLC

Heather Wakelee, MD, associate professor of medicine (oncology), Stanford University Medical Center, discusses the current state of treatment for patients with non—small cell lung cancer (NSCLC).

In the last 5 years, thoracic oncologists have been given a plethora of new treatment options for their patients with NSCLC. Wakelee says that when she first started as a clinician, the paradigm was limited to conventional chemotherapy. In the last 15 years, however, researchers have developed an understanding of the molecular basis of lung cancer and were able to develop corresponding treatments.

For patients who harbor EGFR and ALK mutations or the more rare alterations like HER2, RET, and BRAF, having targeted therapies for those subsets has given physicians greater flexibility. However, where things have changed the most, Wakelee notes, is with the rise of immunotherapy in this field. In the previous years, oncologists had a slight understanding of the role of checkpoint inhibitors, but their knowledge was limited to single-agent activity in the second-line setting. In 2018, the frontline setting of NSCLC has completely transformed, with the approval of an immunotherapy/chemotherapy combination for a majority of patients, unless they harbor a driver mutation, Wakelee explains. Moreover, single-agent pembrolizumab (Keytruda) is available for patients whose tumors harbor high levels of PD-L1 expression.