Oncology News Central Peer-Spectives

Combination regimens improve survival in advanced EGFR-mutated NSCLC, but they also increase toxicity. Jorge Nieva, MD, shares how he talks with patients about potential adverse events. Hedescribes the options available for prophylaxis and how he treats the toxicities that do arise.

Tackling central nervous system (CNS) disease in EGFR-mutated non-small cell lung cancer “is a huge problem, both from a quality-of-life perspective for patients and also from a longevity perspective,” explains Sid Devarakonda, MD, director of thoracic medical oncology at Swedish Cancer Institute in Seattle and clinical associate professor at Washington State University. He speaks with Aakash Desai, MD, MPH, associate director of the Phase 1 and Precision Oncology program at the University of Alabama at Birmingham, about how CNS metastases inform choices between regimens. Dr. Devarakonda also discusses how the recent U.S. Food and Drug Administration approval of subcutaneous amivantamab (Rybrevant Faspro) may change his approach. “[Y]ou still need to be comfortable managing some of the toxicities that still persist, even with the subcutaneous formulation, but it's terribly convenient from a practical perspective,” he notes. Dr. Desai and Dr. Devarakonda reported various financial relationships.

With multiple regimens available for advanced EGFRm NSCLC, selecting the best regimen for an individual patient is key. Jorge Nieva, MD, tells host Aakash Desai, MD, MPH, that the questionshouldn’t be about who needs more efficacy, but rather understanding a patient’s personality and goals.

Progress in cancer care means that millions of patients are living longer lives, albeit without hope of a cure. What role can oncologists and other physicians play in helping to navigate these uncertain futures? “What is our obligation to them? How do we understand them and their needs and respond to them?” asks Sunita Puri, MD, author of That Good Night: Life and Medicine in the Eleventh Hour and associate professor of medicine and director of the inpatient palliative care service at the University of California Irvine School of Medicine. She discusses how she uses “radical honesty” with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer Center in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Dr. Puri explains how she admits her own limitations when helping patients who are grappling with questions about what treatments mean for quality vs quantity of life. “I want to be a resource to you, but I also want you to know I share in your uncertainty because I’m not sure what’s going to happen next.” Dr. Puri reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

A recent study found a link between mRNA vaccination and improved cancer immunotherapy response. The preclinical data demonstrated impressive results, leading to big questions. “We believe that [vaccination] actually does generate and even converts the cold tumors to hot tumors,” Steven H. Lin, MD, PhD, a physician-scientist and radiation oncologist at the University of Texas MD Anderson Cancer Center in Houston, tells Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer Center in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology.