RET Fusion+ NSCLC and COVID-19

Jared Weiss, MD: If I were sitting at home and I hadn’t had the privilege of treating a dozen or 2 dozen patients on 1 of the trials, my next question might be, what am I going to use the next time I find RET? You’ve told me, you’ve armed me with whatever next-generation panel I can order. I’m going to pick up some RET now and again. What should I order? Do you see any key differences among these trials or drugs?

Benjamin P. Levy, MD: I don’t know. The initial presentation looked like a response rate of 58%. The updated analysis at ASCO [American Society of Clinical Oncology Annual Meeting] for pralsetinib by Dr Justin Gainor looks like the response rate is around 65%, which is identical to selpercatinib. I don’t know if there are any meaningful differences in these drugs. There may be some differences in toxicity. Unbiased, as you mentioned, and I think you are too—we’ve only used selpercatinib. That’s probably going to be my go-to drug only because I’m a creature of habit and have put so many patients on the study. I would certainly be willing to give pralsetinib a try. It looks similar. The waterfall plot, if you put them next to one another—maybe a few of those bars don’t reach the 30% line on the pralsetinib arm that reached it in the selpercatinib arm, but they look fairly similar to me. I don’t know if there are going to be meaningful differences between these 2 drugs. I don’t know. What are your thoughts on that?

Jared Weiss, MD: Unless you work for 1 of the companies or you’re an analyst, these look much more similar than different.

Benjamin P. Levy, MD: Yeah.

Jared Weiss, MD: Anything different in the era of COVID-19 [coronavirus disease 2019] in terms of patient selection or management of toxicities?

Benjamin P. Levy, MD: Yes. I’ve been on many COVID-19 calls, and I think we’re getting back to normal. The oral therapy certainly helped. Sometimes we can manage these better through telemedicine than a patient coming in every 3 weeks. That said, I still try to bring these people back so we can monitor that. I don’t try to marginalize their care unless we can do an optimal video, a telemedicine. I’ve gotten video-telemedicine fatigue. In the era of COVID-19, I don’t think the targeted therapies’ implementation or following has changed all that much. Maybe they don’t come back for 1 visit or 2 visits where I would have seen them and done labs. Maybe we do the labs off-site and we do a telemedicine visit rather than come back. I am protective of these patients. I do like to see them every 6 to 8 weeks to check in on them or via telemedicine. I know that’s aggressive, but I do like to lay eyes on them every 6 to 8 weeks just to see how they’re doing.

Jared Weiss, MD: I think that’s being a good doctor.

Benjamin P. Levy, MD: Yes. Any COVID-19 changes for these patients?

Jared Weiss, MD: The major change is that COVID-19 has accelerated our experimentation with virtual care out of necessity. I’m thinking about which populations it has gone well for and which it has not. For targeted therapy populations, it has gone much better than for my chemotherapy or chemotherapy I/O [immuno-oncology] patients. There are a number of reasons. They tend to have fewer adverse effects, but also, they’re more likely to be socioeconomically advantaged. And along with socioeconomic advantage comes broadband, internet, and social support. Someone else will call if there is a problem. In particular, broadband internet is a big deal. If I can see you face-to-face and we can see each other’s facial expressions and we can understand the words that we’re speaking to each other, that’s going to be a much higher-quality doctor-patient interaction than if the video is cutting in and out and the words sound like a robot and I understand every other word. For our targeted therapy population, I’ll probably do a lot more virtual care even after COVID-19 is over. Some of these patients travel a great distance to see their doctors. You’re at Hopkins the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, so your travel distance is probably hours on average, and you can probably care for some of these patients just fine for many of those virtual visits. My travel distance, because I’m at an academic institution and on clinical trials but also because we’re the state hospital, is quite long. For patients who have good broadband so we can properly understand each other, I’m going to keep doing mostly virtual for my targeted therapy patients.

Benjamin P. Levy, MD: That’s not a bad idea. We’ll see how the world changes after COVID-19, whenever that is.

Transcript Edited for Clarity