Lung Cancer Awareness Month: Treatment Updates in 2024

As Lung Cancer Awareness Month progresses, OncData Editorial Board and Fellows Forum members Dr. Waqas Haque, Dr. Joseph Kalis, Dr. Nagashree Seetharamu, and Dr. Matthew Hadfield shed light on the advancements in lung cancer therapies, unmet needs, the evolving landscape of molecular testing, and actionable insights for clinicians.

Hear additional insights from World Lung Cancer Day here!

Breakthrough in Small Cell Lung Cancer Treatment: Tarlatamab

Matthew Hadfield, DO, highlighted the groundbreaking role of tarlatamab, a bispecific T-cell engager approved for relapse/refractory small cell lung cancer (SCLC).

What clinicians need to know:

• Mechanism of action: Tarlatamab links T cells with cancer cells by targeting CD3 and DL3, promoting targeted immune activation
• Patient outcomes: Tarlatamab improves survival rates in second-line SCLC treatments compared with traditional therapies like topotecan
• Limitations: Tarlatamab requires inpatient monitoring for cytokine release syndrome (CRS) and associated toxicities (eg, hypotension, fever). Availability may be limited in rural or less-resourced settings
• Future outlook: Wider adoption of T-cell engagers like tarlatamab over the next decade requires infrastructure improvements and streamlined CRS management protocols

Optimal Dosing Strategies

Waqas Haque, MD, MPH, discussed the pivotal shift in drug development paradigms. The approval of tarlatamab at a lower 10-mg dose (compared to 100 mg) reflects a growing emphasis on minimal effective doses over maximum tolerated dose (MTD).

Key benefits:

• Reduced toxicity risks, such as CRS and immune effector cell-associated neurotoxicity syndrome (ICANS)
• Improved patient tolerability and adherence

The FDA’s Project Optimus further supports this trend, aiming for earlier dose optimization in drug development.

The Role of Molecular Testing in Precision Oncology

Molecular testing is integral to determining treatment paths for lung cancer patients. Nagashree Seetharamu, MD, and Dr. Hadfield stressed its importance, particularly in non–small cell lung cancer (NSCLC).

Clinical recommendations:

• Driver mutations: Targeted therapies for EGFR, ALK, and KRAS mutations offer superior outcomes
• Timeliness: Early submission of tissue for testing accelerates treatment planning, preventing delays
• Patient advocacy: Advocate for patients to receive next-generation sequencing (NGS) to identify actionable mutations

Future trends:

• Broader genetic panels for rarer fusions via RNA-based platforms.
• Increased adoption of germline testing, as seen in BAP1 mutations in mesothelioma

The Evolving Scope of Cancer Screening

Dr. Seetharamu and Joseph Kalis, PharmD, BCOP, addressed the critical need for improved lung cancer screening rates and accessibility.

Challenges in current screening practices:

• Barriers: stigmatization of smoking-related cancers, lack of awareness, and disparities in access
• Emerging trends: revising screening criteria to include individuals with lower tobacco exposure and addressing the increasing incidence of lung cancer in non-smokers, potentially driven by environmental pollutants

Call to action for clinicians:

• Partner with community oncology practitioners to facilitate equitable screening access
• Advocate for expanded screening guidelines to identify at-risk populations

Addressing Stigma in Lung Cancer

Lung cancer, particularly in smokers, carries significant stigma, often impacting patient care. Dr. Hadfield emphasized the importance of separating patients’ personal histories from their disease.

Key takeaways for clinicians:

• Reinforce to patients and families that cancer is not their fault
• Encourage open, judgment-free conversations to ensure adherence and trust

Environmental and Advocacy Challenges

Dr. Haque noted the role of environmental factors in cancer development, with over 80,000 pollutants identified as potentially harmful. He highlighted the importance of advocating for stricter environmental regulations, including banning substances like asbestos.

Conclusion

From cutting-edge therapies like tarlatamab to the importance of molecular testing and equitable screening, the oncology field is rapidly evolving. Clinicians must stay updated on these advancements to provide optimal care. Advocacy for patients—both in the clinic and the community—remains central to addressing disparities and stigma in lung cancer care.

By embracing innovation and collaboration, the oncology community can continue to improve outcomes for lung cancer patients worldwide.

About the Speakers

Waqas Haque, MD, MPH, is a Hematology/Oncology Fellow at the University of Chicago. He recently completed his Internal Medicine Residency at New York University (NYU) in a Clinical Investigator Track. Dr. Haque has balanced his patient care work with a variety of research projects. During his fellowship training at the University of Chicago, he plans to further his work in innovative clinical trial design, value-based care delivery to cancer patients, and clinical investigation.

Joseph Kalis, PharmD, BCOP, is an Ambulatory Oncology Clinical Pharmacy Specialist at the University of Colorado Health. In this position, he educates patients about their chemotherapy and immunotherapy treatments, reviews treatment plans and dose adjustments, and assists with supportive care. Dr. Kalis’ professional interests include multiple myeloma and hematologic malignancies. He enjoys teaching learners from all walks of life. Dr. Kalis has spoken extensively for continuing education programs, along with various peer-reviewed papers on oncology and pharmacy.

Nagashree Seetharamu, MD, is a Professor in the Department of Medicine, Division of Hematology and Oncology, at the Barbara and Donald Zucker School of Medicine at Hofstra/Northwell Health. In addition to being a nationally and internationally renowned thoracic and head and neck oncologist, with a busy clinical practice, she is a very active academician. She has conducted several research projects in the fields of lung cancer prevention, early detection, predicative and prognostic biomarkers, as well as novel therapeutics in thoracic and head and neck oncology. In addition, Dr. Seetharamu is passionate about mentoring the new generation of oncologists and plays an active role in the fellowship program at Northwell Health. She also serves as a mentor for trainees in other institutions through the ASCO mentorship program.

Matthew Hadfield, DO, is a Medical Oncologist at Brown University/Legorreta Cancer Center, with a pending faculty appointment at the Warren Alpert School of Medicine of Brown University. Dr. Hadfield’s clinical and research interests are in phase 1 clinical trials and developmental therapeutics, as well as cutaneous malignancies and immunotherapy-related adverse events. He recently completed his Hematology/Oncology Fellowship at Brown University.