Lung Cancer: Navigating Discussions at Diagnosis

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The views and opinions expressed in this article do not constitute medical advice. Patients should always seek medical advice and guidance from their doctors. Teresa has a paid relationship with EMD Serono.

After spending more than 25 years living in France, Teresa* was excited about returning to her home state of California – to spend more time with her brothers and to see her daughter graduate from her former high school.

While settling back into life in San Francisco, Teresa developed a persistent cough. She thought perhaps her time in France had made her more susceptible to the California allergens. Through visits with her general practitioner, Teresa was initially treated for allergies and then later acid reflux disease – but her symptoms persisted, and she knew something still wasn’t right. Teresa continued to cough constantly, and she was coughing up yolk-sized and -colored spots and blood. A concerned friend urged her to see a new doctor to get to the bottom of her symptoms.

“I had noticed I was rapidly losing weight and had a sudden aversion to food, which was unusual for me,” Teresa recalls. “After an X-ray revealed a large mass in my right lung, I had further testing that confirmed I had stage 4 metastatic non-small cell lung cancer, due to the size of the tumor (15 centimeters) and having spread to the lymph nodes, as well as a few nodules in the pleura.”

As she began consulting with oncologists, Teresa learned that non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Teresa was part of the more than 50% of people with NSCLC who have metastatic disease at the time of diagnosis, meaning the cancer has already spread beyond the lungs. For those with metastatic disease (stage 4), the 5-year relative survival rate is just over 6%.

“I was completely overwhelmed at first. But slowly, with the support of my friends, my son and daughter, and resources from patient organizations, I began to understand the tools available to help me navigate my diagnosis,” she says.

Teresa realized that her initial diagnosis only told part of the story. She learned about the role of biomarker testing in NSCLC, which can help doctors make decisions about appropriate treatment plans. In recent years, researchers have identified several different genetic alterations, or mutations, in NSCLC cancer cells that drive the cancer’s growth. This includes the alteration Teresa was diagnosed with, mesenchymal-epithelial transition (MET) exon 14 skipping alterations, a type of alteration that is estimated to occur in 3-4% of people with NSCLC. Such a tumor alteration can be identified through biological markers, or biomarkers – and may be used to identify appropriate treatment options.

“I am so grateful I was able to learn about and understand that METex14 skipping was playing a role in my cancer,*” Teresa said. “Though I hadn’t started treatment yet, I recognized early the value of seeking out community resources and advocating for oneself to ensure a comprehensive diagnosis, including biomarker testing.”

Evolution of Targeted Treatments for NSCLC

More than half of people with NSCLC may have genetic alterations driving their tumor growth. Using comprehensive biomarker testing is important to identify these genetic mutations or other markers that may help doctors make decisions about appropriate treatment plans. Biomarker testing may also be called genomic testing, genomic profiling or molecular testing. With a full picture of their disease, people with lung cancer can work with their health care providers to develop an appropriate care plan for their specific cancer type. Recent advancements in targeted treatments have increased the treatment options available to people with metastatic NSCLC.

Dr. Marc Matrana, Director, Ochsner Precision Cancer Therapies Program in New Orleans, says targeted therapy for NSCLC has changed the way doctors manage the disease, providing more hope for patients with limited treatment options.

“The treatment of lung cancer is, arguably, leading the way in terms of progress for personalized medicine in oncology. As our understanding of lung cancer on a molecular level has continued to grow in recent years, more of the genetic mutations that drive some forms of this cancer—as well as therapies that can specifically target them—have been identified,” said Matrana.

“Comprehensive biomarker testing is a crucial part of cancer care. The opportunity to identify an actionable rare mutation in one of my patient’s tumors is incredibly exciting because it opens treatment possibilities that can impact the trajectory of that person’s disease, and potentially improve their prognosis.”

For adults with metastatic NSCLC with METex14 skipping alterations, the U.S. Food and Drug Administration has approved a targeted treatment option called TEPMETKO® (tepotinib).** TEPMETKO® is indicated for the treatment of adult patients with metastatic NSCLC harboring MET exon 14 skipping alterations. This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trial(s).

The views and opinions expressed in this article do not constitute medical advice. Patients should always seek medical advice and guidance from their doctors.

*Teresa has not received treatment with TEPMETKO.

-What is TEPMETKO used for?

TEPMETKO is a prescription medicine used to treat adults with non-small cell lung cancer (NSCLC) that:

-whose tumors have an abnormal mesenchymal epithelial transition (MET) gene. Your healthcare provider will perform a test to make sure that TEPMETKO is right for you.

It is not known if TEPMETKO is safe and effective in children.

-What Warnings should I know about TEPMETKO?

TEPMETKO may cause severe or life-threatening swelling (inflammation) of the lungs during treatment that can lead to death. Tell your healthcare provider right away if you develop any new or worsening symptoms of lung problems, including: trouble breathing; shortness of breath; cough; or fever.

TEPMETKO may cause abnormal liver blood test results. Your healthcare provider will do blood tests to check your liver function before you start treatment and during treatment with TEPMETKO. Tell your healthcare provider right away if you develop any signs and symptoms of liver problems, including: your skin or the white part of your eyes turns yellow; dark or “tea colored” urine; light-colored stools (bowel movements); confusion; tiredness; loss of appetite for several days or longer; nausea and vomiting; pain, aching, or tenderness on the right side of your stomach-area (abdomen); weakness; or swelling in your stomach-area.

TEPMETKO can cause harm to an unborn baby in pregnant women.

Females who are able to become pregnant:

-Your healthcare provider may do a pregnancy test before you start treatment with TEPMETKO.

-You should use effective birth control (contraception) during treatment and for 1 week after the final dose of TEPMETKO. Talk to your healthcare provider about birth control methods that may be right for you.

Males with female partners who are able to become pregnant should use effective birth control during treatment with TEPMETKO and for 1 week after the final dose of TEPMETKO.

-What should I tell my health care provider?

Tell your healthcare provider about all of your medical conditions, including if you:

-have or have had lung or breathing problems other than your lung cancer

-have or have had liver problems

-are pregnant or plan to become pregnant. TEPMETKO can harm your unborn baby.

-are breastfeeding or plan to breastfeed. It is not known if TEPMETKO passes into your breast milk. Do not breastfeed during treatment and for 1 week after the final dose of TEPMETKO.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

-What are the side effects of TEPMETKO?

The most common side effects of TEPMETKO include: swelling in your face or other parts of your body; tiredness; nausea; diarrhea; muscle and joint pain; and shortness of breath. Your healthcare provider may change your dose, temporarily stop, or permanently stop treatment with TEPMETKO if you develop serious side effects during treatment. These are not all of the possible side effects of TEPMETKO. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

Please see the full Prescribing Information and Medication Guide for additional Important Safety Information for TEPMETKO.

For more information on metastatic NSCLC with METex14 skipping alterations, visit: www.TEPMETKO.com.

© 2021 Merck KGaA, Darmstadt, Germany and/or its affiliates. All rights reserved.

** TEPMETKO® is a trademark of Merck KGaA, Darmstadt, Germany or its affiliates. EMD Serono Inc., is the Healthcare business of Merck KGaA, Darmstadt, Germany in the US and Canada.

US-TEP-00411 September 2021