5 PRACTISE CHANGING DEVELOPMENTS IN LUNG CANCER IN 2017

PACIFIC trial shows huge and sustained progression-free survival (PFS) benefit for unresected stage III non-small cell lung cancer (NSCLC).Although survival data are still immature, the improvement in PFS with 1 year of maintenance durvalumab after chemoradiotherapy is of such magnitude (hazard ratio, 0.52) and maintained for so long (44% vs 27% at 18 months) that this should change the standard of care in a setting in which we have been at an impasse for more than a decade. 

FDA approval of carboplatin/pemetrexed/pembrolizumab for advanced non-squamous NSCLC. Though many—myself included—feel that the FDA decision to approve this chemoimmunotherapy combination on the basis of a randomized phase 2 trial with 123 patients, and no significant survival benefit, was premature, it is changing broad practice now as we await phase 3 data on various combinations of PD-1/PD-L1 checkpoint inhibitors with platinum-based doublet backbones.

US FDA approval of broad genomic testing for advanced solid tumors.Although I think there will be unintended negative consequences, with an escalation of costs and possible harm as oncologists pursue molecular therapies with scant, poor-quality data, broader next-gen sequencing testing will enable patients with rare but treatable targets to be identified and will accelerate research in molecular oncology.

FLAURA trial moves osimertinib into first line for EGFR mutation-positive advanced NSCLC. Some may insist that we need to hold out for a significant improvement in survival from osimertinib over first-generation EGFR tyrosine-kinase inhibitors gefitinib or erlotinib, but the PFS benefit (HR 0.46; median, 18.9 vs 10.2 months), combined with a favorable toxicity profile, central nervous system control, and access to a better agent for 100% of patients, instead of only 50%-60% at most, leads me to consider this a clearly preferable first-line strategy.

Growing data for immunotherapy in relapsed small cell lung cancer. We don't yet have prospective phase 3 randomized trial results, but mounting data support combination or potential single-agent immunotherapy in a setting where our existing alternatives are profoundly disappointing.