Lung Cancer Developments: Good for Patients, Harder for MDs скачать в хорошем качестве

Lung Cancer Developments: Good for Patients, Harder for MDs

Dr Mark Kris discusses how benefits in the field of lung cancer make decisions more difficult for physicians. https://www.medscape.com/viewarticle/... -- TRANSCRIPT -- Hello. It's Mark Kris, from Memorial Sloan Kettering, speaking today about the truly amazing developments in the field of lung cancer, particularly adenocarcinoma and squamous carcinoma during 2024. The issue that has come up now is that with each piece of information that shows that a drug is useful or effective, there are often as many questions as there are benefits that have been presented, both in presentations and in papers. I want to go over some of those today. I don't have all the answers to advise you how to choose the best therapy, though I'll give you some suggestions as we go along. Let's first start with durvalumab in the perioperative setting. In June of [2024], there were results of a large, randomized trial giving durvalumab as an adjuvant treatment for patients completely resected with lung cancer. They found that durvalumab did not meet the primary endpoint of progression-free survival when given adjuvantly. Just a month or so later, however, there was an FDA approval for perioperative durvalumab. In the trial that was reported, durvalumab was given with chemotherapy prior to surgery and then for approximately a year after surgery. There was a clear benefit in the durvalumab-containing arm in terms of event-free survival (EFS), which was the primary endpoint of the study. In the discussions around these presentations and the approval, it came up that the FDA raised important questions concerning the need for postoperative durvalumab and the degree of benefit of the postoperative durvalumab to the overall treatment regimen. As many of you know, there are trials giving only preoperative therapy that showed levels of benefit comparable to those giving perioperative therapy, as the term is now, both adjuvant and neoadjuvant therapy. One issue is whether it is necessary. Another issue is whether or not you would be exposing people to toxicity and inconvenience by giving a year of therapy. The FDA has challenged people designing trials that they need to consider the components of the trial and to show the benefit of each component of the trial, so the postoperative vs the preoperative. What's a doctor to do here? Clearly, there's no conclusive evidence that adjuvant durvalumab is a recommended treatment, and it's not undergoing any approval, as far as I know, anywhere on Earth. What about the perioperative setting? There are significant questions remaining there. I think one thing you have to do, though, about neoadjuvant and/or perioperative checkpoint inhibitor and chemotherapy is look at all the data in that situation. There has not been a single trial reported — not one — that says that preoperative checkpoint inhibitor, durvalumab included, with chemotherapy did not improve EFS. You really have to be impressed in this illness that every single trial has met that EFS endpoint. That is unheard of. There are also data from other diseases showing that neoadjuvant provides a better overall outcome than the same drugs given adjuvantly, and not given neoadjuvantly. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/...