Published on June 25, 2020
Lung Cancer Research Continues Despite COVID-19
Are lung cancer clinical trials and research still going on despite the pandemic? What about new treatments?
In this segment from our recent Lung Cancer Answers Now program, two experts assure patients that research and clinical trials are still happening. Dr. Heather Wakelee from Stanford University School of Medicine and Dr. Amy Moore from the Go2 Foundation for Lung Cancer give highlights on new drug approvals, including oral and targeted therapies. They also share updates from the recent American Society of Clinical Oncology (ASCO) annual meeting, held virtually this year. Watch now to learn more.
Transcript | Lung Cancer Research Continues Despite COVID-19
Dr. Wakelee, since you are a leader in research, are lung cancer trials continuing, moving forward, even where sometimes resources have been deflected, like Linnea just mentioned?
Yes. And this was something that varied around the world, around the country, and really, depending on how overwhelmed the local healthcare system was by COVID. Certain large cancer centers in metropolitan areas like New York had to stop doing trials briefly because they just... and a lot of cancer care was deferred if it felt like it was safe to do so.
In Northern California, we did adopt pretty strict social distancing early, and we were able to flatten our curve, so we never got overwhelmed. And for that reason, we didn't have to defer cancer care, and we didn't have to close clinical trials. We did close some that we thought were not as urgent, such as some of the specimen collection studies and anything that wasn't already open, we kind of paused to make sure we didn't get overwhelmed. But any trial that was open, we continued enrolling because as Linnea put it very nicely, I mean, if you're living with cancer, you know the cancer's out to get you, and other things can happen too, but if you ignore the cancer, that's what's going to be there, and so we looked at it that way, that our job continued to be to give the best possible care to our cancer patients, with adjustments to keep them safe from COVID-19 as best as possible. But for a lot of people, the clinical trial is the best treatment option. And we didn't want to deny people that.
Amy, any point you want to make about from the foundation's point of view about research moving forward, and the people affected by lung cancer still paying attention to that as a lifeline?
Sure. I mean, I think that is a concern that was raised across the community we serve as well as the other advocacy organizations. This palpable fear in the early days of the pandemic, especially on the part of lung cancer patients, that research had come to a stop, and we know how much progress we have made recently. As I say, at the beginning of the year, we were celebrating the largest drop in a single year in cancer mortality, much of that attributed to advances that were born from lung cancer research, immunotherapies, targeted therapies. And it was very real that patients were concerned that may come to a halt, and what did that mean for their care going forward and for new lifesaving advances.
And what we have found is that we're continuing to make progress, as Dr. Wakelee described, it looked different. I'm trained as a basic scientist. So research across the country, a lot of academic institutions had to close down their labs temporarily as we sheltered-in-place. And now we're beginning to see laboratories reopen under precautions. So they continue to have to space themselves out in the lab. But research is resuming. We've made swift and significant progress even during the pandemic, and we can get into this, but there's been a flurry of recent FDA approvals in the lung cancer space. All that is to kind of affirm to the community that research hasn't stopped, that clinical trials are continuing. We recognize that lung cancer research, cancer research must continue. And in everyone who's involved in that is dedicated, as Linnea said, to figuring out how to adapt and work around the unusual obstacles and circumstances we find ourselves in. Hope is real, research is continuing, and patients should be encouraged by that.
We're going to go to Amy for a second in a minute, but just to get the overview from this ASCO meeting, what impressed you? For people with lung cancer, it may result in different types, but what was the big deal?
Before we get to that, I have to say the FDA has approved an enormous number of new lung cancer options for our patients just in the last month. Literally, every time I open the news in the morning, I'm like, "Oh, there's another approval." I mean, it's just been phenomenal. So a lot of hope, and some are the targeted therapies, and we have now approved drugs for RET and MET, which we really didn't have before, so those are some of the less common, but real driver mutations, and then a lot of immune therapy options. It's really a rapidly changing field.
At ASCO this year, I was impressed by... and ASCO is our premier meeting every year, there're several different ones, but there were some treatments for the EGFR subtype known as exon 20, which has been one that's been pretty challenging to treat. And so, there was work looking at giving a standard drug at high doses, so this is osimertinib (Tagrisso). Lecia but also Zofia Piotrowska had led that effort. So a lot of work going on in Boston, and this was also an ECOG-ACRIN effort. And then another drug called amivantamab (JNJ-61186372). So, this is an IB drug that's targeted. We think about those being pills, but there's a lot of newer antibodies, so immune therapy, but not directly, it's sort of a more complicated way of doing that.
And then more data on some of the targeted pill drugs for MET. And there was also, what I thought was really exciting because I have patients with these, HER2 mutations. So again, less common, but a real subset of lung cancer, specific mutations there. There was a drug called trastuzumab deruxtecan, which had a really high response rate, which seemed durable, and I unfortunately lost a couple of patients with that specific mutation in the last six months. And so to see some hope, there was very encouraging for me.
And then for immune therapy, there was a drug that targets something called TIGIT, which is another immune modulator that seemed to add to some of the checkpoint inhibitors, so that was really great. And then a lot of work on combining two immune therapies, the ipilimumab (Yervoy) and nivolumab (Opdivo). Updates on patients doing really well for a long time with that combination, and also looking at it in combination with chemo. So we have a lot of chemotherapy plus checkpoint inhibitor trials, and standard treatments now, which are really looking quite exciting and have worked beautifully for many patients. And that's also true in small cell. So we had also updates on small cell chemo plus checkpoint inhibitors, and that's really become the standard approach now because we've had four trials that have all shown a benefit to doing that.
So those were just some of the things. And then there was also work on patients with earlier stages of cancer, looking at when there is a mutation, instead of giving chemo after surgery, can we give the targeted therapy after chemo? And so there was a big trial with a drug called osimertinib, which looked encouraging. There's a little debate on that also because we don't know if it's improving cure, but it absolutely is preventing the disease from coming back for longer. And so it's a really important point of discussion now for patients who have early stage cancer, that's been removed.
Okay. One question that came in, and then Amy, I want to get your perspective on this and Linnea too, but Dr. Wakelee, someone wrote in and it says, are there any new results about the brigatinib (Alunbrig) after alectinib (Alecensa) for ALK-positive patients?
So that's a great question. So as I had mentioned, there are five FDA approved drugs, there are others in development. I've been involved in trials with one called ensartinib, but there's a large number of them. And the question gets to, well, what do we do when one of these drugs stops working? Do the other ones work? And that gets into details around the specific reason it stops working. So there are similarities and differences with all of the ALK drugs. If the reason the first one stopped working is similar to why the second one works, then that probably wouldn't be a good choice, but if there's a new mutation, and the second drug is sensitive to that mutation, then you can get responses. And so lorlatinib (Lorbrena), we know, can work after some of the drugs. There are patients who have lorlatinib work after alectinib, but trying to put, well, what's the probability? We don't have enough information to answer that yet.
Okay. So Amy Moore from the GO2 Foundation, Dr. Wakelee rattles off new approvals, and combinations, and more research going on, Linnea, you're listening carefully, I'm sure, to all of this, and for all the people you deal with on social media as well. So how does the patient get what's right for them in an emerging time when it's complicated for the docs and certainly complicated for the patient?
For sure. And a big part of what GO2 Foundation does is patient education and empowerment. So we have a team that focuses on patient services. You know, from the research standpoint, part of what my team helps to do is we have a program called LungMATCH, which is really clinical trials navigation. So we can, through fielding calls or a helpline, we can patch patients through to that LungMATCH team, which is staffed with PhD level and masters level scientists who...They go to all these meetings, they go to ASCO and AACR, so they have their finger on the pulse of these rapid advances. They know what the new FDA approvals are, and they can help patients learn the latest and be empowered with that information. They can point them to the trials that might be appropriate, so they can have those conversations with their treatment team. We don't necessarily provide that medical advice directly, but we can be part of that conversation. And so much of what we want to do again, is around this education and empowerment piece. But that's a big piece that we're focused on is that dedicated, specialized, personalized trials navigation.
So Linnea, you are a pretty outspoken patient and patient advocate. What do you want to say to people, whether it's about clinical trials or now figuring out whether one of these new approvals or combinations is right? How active should the patient in the family be now in a discussion with a knowledgeable doctor to get what's right, to get the right testing and get the right treatment?
I think part of it depends on what part of your journey you are in. Certainly, everybody should be tested. The difficulty when you're in a situation like mine, being ALK-positive, is it's like I'm on a branch that I've been on for a long time, but it's getting thinner and thinner. And it's been quite a few years since there was an ALK inhibitor developed. And I don't know that there will be a fourth generation ALK inhibitor. So it behooves me to know as much as I can, but sometimes that's also discouraging because it's not like going into a candy store, and you know, there's lots of selections. I'm fortunate to have formidable oncologists who do so much of the hard work for me. But lately, I have been thinking about, wow, could I develop my own clinical trial?
Because in my case, each time I have developed resistance, we have re-biopsied, and we have established what my secondary mechanisms of resistance are. And I have quite a few now. So that means that there are actually very few drugs that are appropriate for me. So as wonderful as it is to still be alive, it doesn't get easier. I think that's the tricky part, is hanging on to that hope, you know? Just hoping that if you can continue to live, something will be developed.