Educated Patient® Lung Cancer Summit Targeted Treatment Panel: June 25, 2022

This panel was moderated by Ryan McDonald, and featured Elisabeth King, Dr. Edward S. Kim and Terri Conneran.

McDonald: To start, I would like to welcome Terri. Off camera, you told me a little bit about your case. So, I was wondering if you can briefly, you know, share with the audience your case, and how you are living proof of what Dr. Kim was just saying about how we need more clinical trials.

Conneran: Oh, Dr. Kim was so spot on. And I love the Bulls analogy, because it really hits home not only that I'm originally in Chicago but it's exactly it. Super quick version, I was diagnosed with lung cancer, it took three years, two opinions, two recurrences to find out that that biomarker was on the reports because it wasn't getting the report, and didn't know what it was. And then when I did find out that it was KRAS, did even more analysis to find out that I don't have G12C. The difference between G12C and the other KRAS (mutations) is the G12As and G12Ds and so on and so forth is precisely why we need the clinical trials.

It's so exciting that we have a G12C inhibitor (that is approved). We've got more that are coming. But we're not there yet. And I know as a patient now doing the efficacy. And having learned about this, how incredibly important it is that those clinical trials are having today. They're working on the drugs for tomorrow. And so we're not where we need to be, but we need to keep working for it. And it's a result of the precision medicine. It took us 40 years to be able to find the first drug for what was considered undruggable. And that's not what anybody wants. We want to be able to have drugs and options. And so we're still in kind of a standard of care. But we're getting better with it. So it's all about precision medicine, is all about picking KRAS.

McDonald: Thank you, Terri. Elisabeth, I want to turn to you. There was a question about, testing for certain mutations. So I'll kind of broaden it out. Where are we in terms of identifying lesser known mutations? For instance, this person mentions STK11. Where are we in terms of finding these lesser heard of mutations?

King: Yeah, that's a great question. And I think that it very much depends on the individual test that's being done. You know, there are tests that look at, you know, 500-plus different sort of biomarkers. I think Dr. Kim's story of the patient who had so much data and nobody knew what to do with it. That's what we run into sometimes. And so I think there's kind of varying, you know, kind of practice styles about how comfortable folks are with that. You know, do you want a bunch of information that you're not really sure what to do with today? Because that makes people uncomfortable, right? It makes clinicians uncomfortable, it makes patients uncomfortable. Or do you want to get those sort of very large kind of panels and say, “Well, I'm uncomfortable with this today. But tomorrow, there may be a, you know, really cool new treatment.” So we still want the data.

So those tests do exist. I think it's really variable on, you know, kind of where you're having the test, what part of the country, you're having the test and sort of also eligibility for clinical trials. If you're sort of dabbling in these kind of newer biomarkers, having the ability to enroll those folks onto clinical trials is really, really important. That is kind of part of that newer biomarker therapy. I also want to compliment Dr. Kim, every time he kind of speaks about that kind of expanding eligibility. I'm just so inspired and blown away. I think that's like really, really important work. But the other thing I do want to mention is this idea of implementation research, you know, where there are some centers who were on top of the research and sort of immediately using it to treat patients. That is often a little bit slower to get out across the country and in the rest of the world. So I think we need to expand that knowledge but I would also encourage all of our patients to really advocate for themselves, and make sure that they are being tested for, you know, everything they can be tested for.

McDonald: Thank you. Dr. Kim, I'd like to throw a question your way and kind of incorporate breast cancer into this as you kind of talked about it at the start of your presentation with the data out of ASCO, looking at HER2-low. In lung cancer specifically, you know, if someone doesn't necessarily have a targetable mutation or biomarker or what have you, but there's like small presence of one, is there a treatable option for that? How common is that? Can you talk about the space in lung cancer?

Kim: You know, a lot of the focus today has been on biomarkers. And I think it's such a crucial aspect. I was recently on a call and, and stated, you know, this is so important, we shouldn't consider a patient completely staged and diagnosed until we have those results. It needs to be like breast cancer, where we have HER2, (estrogen receptor [ER]) and other things. I mean, the fact that we're not getting 100% testing or even high 90 (NGS panels) in patients upfront, and we don't even measure whether they're utilized upfront.

So we're testing data that we're getting, people are having testing done, but they're not completed by the time that initial treatment is done. So we have a lot of work to do there. So that's number one. Before we get to any other therapies, we've learned from immunotherapy that, you know, having a higher expression level of something like PD-L1 can help. But that other combination therapies pretty much nullified that biomarker effect, and that just shows you it's not a great biomarker. It's okay. And it can guide us to use single agent, but not overcome combinations with other therapies like chemotherapy.

We do have drugs like antibody drug conjugates, ADCs, that are coming. And although those are not in our true sense, targeted therapy, because they use overexpression of a receptor to deliver cytotoxic compounds. So it's sort of like a smart way of treating as opposed to the previous ways of just giving everyone cytotoxic chemotherapy, that's shown us that we can make some differences in folks who have lower expression, because a lot of times again, these markers aren't the greatest markers. And a lot of the cells over express these, especially with some particular cancer cells, they can have a little more expression than others. So there are other methods we're trying to utilize. There are many other therapies being developed. So if you don't have a biomarker that fits one of these categories, no worries, there's a lot of great other therapies that are being developed. So don't feel like “Oh, darn, I don't have a biomarker.” There's many others that are being done. So we're just talking about one of the aspects that has really changed.

McDonald: Thank you, Dr. Kim. Elisabeth, coming back to you, a couple of questions about this. So you know, I want your opinion and kind of inform everybody. But is there a benefit to continuing biopsy, liquid biopsy, in particular after there is no evidence of disease to predict early resistance?

King: That is a great and complicated question. So liquid biopsy, actually, they're sort of different tests that do different things. And probably what this patient is thinking of is less about resistance and more about recurrence. And so there is a different type of liquid biopsy, which was not the type that I really talked about today, that looks at whether disease is present or not, right? Because if we are drawing blood, and we're looking for the cellular contents of a cancer cell, we need kind of a lot of that DNA to do kind of targeted sort of tissue biomarker testing. And so that's one sort of test.

There is another test that just looks for the presence of those cancer cell contents. And so just Is it there or not? It's a yes or no. And we will sometimes use that sort of testing, particularly seeing it used the most in colon cancer. Like for example, after somebody has had a surgery, we can go and we can do some liquid biopsy testing and say, did we get all of the cancer or is there still a little bit of cancer cell sort of evidence of that in their blood? And if so, then we need to think about chemotherapy. That is very sort of early technology. Again, I think it's really exciting. I suspect it's going to be used more as it's sort of developed. I have not seen it used a ton in lung cancer. And Dr. Kim, correct me if you have seen kind of this these (minimal residual disease [MRD]) assays used in lung cancer, but I suspect it will go there eventually.

Kim: Yeah, I think that's right, Elisabeth. I mean, there's a lot of things being explored right now. You know, people are taking the concepts, I think there's really no limits on what we can test. Now, in the various situations. The fact that we're testing biomarkers in the earlier stages of lung cancer, now, they're going to be tested on this as you will be the front and foremost of it in people who are healthy, high risks, we're trying to detect cancer. And that's going to be complicated, as well. But this is the direction it's going and appropriate.

McDonald: Okay, thank you. Well, we are running short on time. But I do want to get one more question in there for Terri. Can you inform the audience how KRAS Kickers can help for any needs that they may have?

Conneran: Okay, well, thanks for the question. The KRAS Kickers is all about the KRAS patients and KRAS community. And so there's nothing more hopeful and more inspiring to be able to connect with other people, they have something similar to you. And sometimes it's just like their virtual hug. But we can be all around that part of the information. And we keep like a current list of KRAS clinical trials, like up on the website. And so we're focused around that. And we work in conjunction with our other partners, the wonderful people of LUNGevity, Go2 Foundation, and many different hospital settings on here that are on call. So it's all about bringing everybody together all the people with (lung cancer).

McDonald: Okay, perfect. And lastly, Dr. Kim, I'll kind of wrap this up. But can you speak to the importance of having, you know, these systems out there and advocacy groups and all that for patients?

Kim: I think that Terri has been doing an amazing job. And we absolutely have to have that voice. When we were developing our eligibility criteria teams, we had so many engaged patient advocates, you know, when I was chairing the CIRB, we had great patient advocates that, you know, we're really pushing that actually have people like Terri and others at the table when we are designing clinical trials. I mean, why are we waiting till afterwards, we need to get these voices involved earlier, because you know what, somebody's got to tell folks look, why are you excluding all these folks? Why this is crazy. You know, you can use yourself as example, I use myself now as you know, I went to Northwestern Medical, and it's like, I probably couldn't get into Northwestern Medical right now, if I try. So, you know, we need patients at the table, say, how can you design a study like this, I would not have qualified, you know, and so, this is the voice that's now needed to really shape how we design trials for the next step, next generations.

This transcription was edited for clarity.

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