Equitable Access Remains a Major Unmet Need in Lung Cancer Care: Deborah Doroshow, MD, PhD

In part 2 of her interview with The American Journal of Managed Care^® (AJMC^®), Deborah Doroshow, MD, PhD, assistant professor of medicine at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, emphasized the importance of introducing clinical trials early as a legitimate treatment option rather than a last resort while highlighting the rapid growth of targeted therapies like antibody drug conjugates and KRAS inhibitors.

She also stressed that thoughtful trial design is critical to generating meaningful results. However, Doroshow said she considers the biggest unmet need in lung cancer care to be ensuring equitable access to new treatments for all patients.

Read part 1 here.

This transcript has been lightly edited for clarity.

AJMC: Clinical trials are playing a greater role in treating patients with lung cancer. How do you make these trials more accessible to patients who may benefit from participating?

Doroshow: One thing that unites almost all of my patients is that most of them have very little familiarity with clinical trials. In fact, I think most people have very little familiarity with clinical trials. They’re not out there in the way that breast cancer awareness is in October, for example, and I find that that’s even true in folks who have a connection to the health professions or are in the health professions themselves.

I try to introduce the idea of clinical trials right away. There’s a big misconception that clinical trials are only for people who have no other options. I certainly always start by asking people what they’ve heard about clinical trials, but it’s important for folks to hear about them, even if one may not be an option at the time of diagnosis, so that they know that every time I’m thinking about what treatment to use for them, I’m considering both standard treatments and experimental treatments and that I want to offer them the full menu of available options so that they can decide what’s right for them.

At the same time, I make it really clear that they’re not going to make me upset or annoyed if they choose not to do a clinical trial, but that it wouldn'‘t be the right thing if I weren’t offering them all the potential options that are out there. I think the more you talk about it, the earlier you introduce this concept, then it really can stick better, and people don’t see it as some sort of last-ditch option, which is really not what clinical trials are. In fact, we recommend thinking about them at every single stage in a patient’s experience with cancer.

AJMC: Your research primarily concerns the use of targeted therapies for cancer and novel agents to target DNA damage. How are these therapies evolving in the treatment of lung cancer, and are there any particularly promising results in this space?

Doroshow: I think we can think about 2 main categories of targeted therapies, and I’m not going to talk about targeted immunotherapies, as that’s really not my main area of research. But we think a lot about our targeted therapies that are pills that might target certain mutations in cancers. Increasingly, we’re seeing an enormous development of antibody-drug conjugates that target either a feature in someone's cancer or they target a shared characteristic among people with a certain kind of cancer.

Antibody-drug conjugates, or ADCs, are just blowing up. There are way more trials than we’ll ever be able to do or make sense of. I think it’s a very, very exciting area, yet at the same time, we need to make sure that we’re thinking about which trials to do, thinking about how to design them as intelligently as possible, so that we get the answers we need and can decide without exposing too many patients to a new treatment whether or not it’s safe and effective.

I think clinical trial design is actually a really key part of drug development. Of course, we’re identifying more and more subgroups of people with lung cancer who have targetable mutations and seeing the development of new medications to target those alterations. For example, not only do we have KRAS G12C inhibitors, but we’re starting to see numerous KRAS G12D inhibitors being tested both in people with lung cancer and other kinds of cancers.

I can’t wait to see what comes in the next few years, and I just hope that I can continue to be part of helping make sure that our clinical trial designs are sound so that we can get meaningful answers to our questions.

AJMC: Overall, what do you see as the biggest unmet need today in the treatment and care of patients with lung cancer, and where do you think the field should focus next?

Doroshow: I think we’re doing a pretty good job developing lots of drugs. I think there are probably more drugs out there that we cannot possibly develop all of them. We cannot possibly fill up all of the clinical trials out there, and drug development is done by humans, so our answers are only as good as the studies we design. Yet, we can always do better. Why do we do clinical trials? Because our standard treatments are not good enough, and I think there is still a huge gap between what we have now and what we can do in the future.

Perhaps the biggest challenge, though, is making sure that everybody has access to what’s new, what’s exciting, and what works. I have had patients have their treatment for metastatic lung cancer delayed for several months due to insurance changes or trouble with citizenship, limiting their ability to continue care in the same location.

Folks who live farther away…might take…2 hours to get to my office, even from Staten Island, which is technically a part of New York City, but it’s really far. These kinds of barriers meaningfully limit people’s ability to get the treatments that could help improve their lives and extend their lives. So we’re not doing a good job until everybody has access to these treatments.