Dr Melissa Johnson: Treatment Advances Highlight the Immune System’s Importance in Lung Cancer

September 1, 2020

Melissa L. Johnson, MD, associate director for lung cancer research at Sarah Cannon Research Institute and partner in Tennessee Oncology, discussed the biggest gains in the lung cancer space that have contributed to improved survival for patients.

In an interview for this year’s virtual American Society of Clinical Oncology conference Held May 29-31, Melissa L. Johnson, MD, associate director for lung cancer research at Sarah Cannon Research Institute and partner in Tennessee Oncology, discussed the biggest gains in the lung cancer space that have contributed to improved survival for these patients over the past 5 years.

Transcript

Since you joined Sarah Cannon Research Institute and Tennessee Oncology in 2014, what do you believe have been the biggest gains in lung cancer that reflect this year’s ASCO20 Virtual Scientific Meeting theme, “Unite and Conquer: Accelerating Progress Together”?

This year’s ASCO Annual Meeting theme is ASCO 2020, “Unite and Conquer: Accelerating Progress Together.” I love our theme. It’s so exciting that this is my boss Skip Burris’ year to be the ASCO president. “Unite and Conquer” really summarizes what we’ve been doing across the world over the last few months, and so I think it’s particularly appropriate this year. Likewise, we’ve been doing a lot of uniting at Sarah Cannon. I can’t believe that I’ve been here for 5 years.

Thinking back over the last 5 years, I think some of the biggest gains in lung cancer research include the recognition of the importance of our immune system for the care of patients with lung cancer. Now all patients with lung cancer will receive immune therapy as part of their first line of treatment in the metastatic setting, and that wasn’t happening 5 years ago. That has been a united exploration, and across the field, we have 5 PD-1/PD-L1 inhibitors approved for the care of lung cancer patients now. So it hasn’t just been 1 company, it hasn't just been 1 sponsor or 1 institution. We have learned so much because of the cumulative knowledge and wisdom gained across all of those trials.

The second gain for the care of our lung cancer patients is a recognition of the importance of molecular profiling in the form of next-generation sequencing [NGS] for all of our patients, ideally, in the first-line setting before treatment is given. In the past, we have done hotspot panels or isolated analyte testing for single mutations. We know now that not only is NGS testing better, it's more effective; it's more likely to identify rare mutations and unique alterations. It’s also more cost-effective to do it in that way, as opposed to piecemeal testing 1 mutation at a time. It has led to many, many different therapy options for our patients that we wouldn’t otherwise know about if we were still testing EGFR, ALK, and KRAS only in our patients.

My third big gain in the care of lung cancer patients is the recognition that we don’t need a randomized phase 3 clinical trial vs chemotherapy to approve targeted therapies for select mutations. I think 5 years ago we were still trying to compare each new therapy to platinum-based chemotherapy for our lung cancer patients. We now know that if you can design trials with selection for particular mutations up front and you can show a benefit north of 50% in terms of response rates, then you have an active drug. And we have many examples in lung cancer now: osimertinib, alectinib, brigatinib; more recently, selpercatinib and capmatinib, just last week alone [the week of May 11], where those trials were not required to undergo a randomized phase 3 trial against chemotherapy as the primary way of showing benefit; even larotrectinib and entrectinib. Those tiny, tiny little subsets of patients across lung and many other tumor types have been approved based on, actually, multiple trials combining their data together. So I think that’s a great step forward in drug development and in the way that we take care of patients.