Future Directions in NSCLC Care: Navigating Pathways, Costs, and Cutting-Edge Therapies

Sawsan Rashdan, MD, University of Texas (UT) Southwestern Medical Center, discusses the transformative impact of targeted therapies and immunotherapies on NSCLC treatment, highlighting the importance of molecular profiling, the role of clinical pathways, and the balance between efficacy and cost-effectiveness in tailoring personalized treatment plans amidst evolving therapeutic advancements.

Sawsan Rashdan, MD: My name is Sawsan Rashdan. I am an associate professor in internal medicine. I practice at UT Southwestern Medical Center, and I focus on lung cancer. I'm also active in global oncology.

How have advancements in targeted therapies and immunotherapies impacted your approach to creating treatment plans for non-small cell lung cancer (NSCLC) patients?

Dr Rashdan: Advancements in targeted therapies and immunotherapies have significantly transformed the treatment landscape of non-small cell lung cancer. These innovations have led to more personalized and effective treatment strategies, improving patient outcomes. For example, for targeted therapies, every few months, we witness the development of new therapies that directly target specific genetic alterations. Drugs like osimertinib target EGFR mutation, and alectinib and lorlatinib now address alterations.

These treatments have shown much improved outcomes and lower side effects profiles compared with the traditional chemotherapies. Now, as far as immunotherapies, immunotherapy has also transformed the treatment of non-small cell lung cancer. We're witnessing extended survival rates that were unheard of a few years ago.

As far as the impact on treatment planning after the development of these new treatment options, these advancements necessitate comprehensive molecular profiling of tumors to identify actionable mutations and biomarkers. This creates a personalized approach that allows for the selection of therapies that will most likely be effective for individual patients, leading to more tailored and potentially more successful treatment plans.

What clinical factors are most critical when selecting a treatment for NSCLC and how do pathways help guide these complex decisions?

Dr Rashdan: Out of the clinical factors that are critical when selecting treatment options for non-small cell lung cancer, I would say molecular profile, performance status of the patient, comorbidities, and also patient preference are amongst the most important factors for choosing a treatment plan from the various treatment options for non-small cell lung cancer. With a wide array of treatment options available now, clinical pathways play a crucial role in guiding clinicians to select the most appropriate treatment plan for each patient based on these specific factors.

How are biomarkers or specific genetic mutations influencing your treatment choices for NLCLC patients, and are there any gaps in testing or pathway recommendations that could improve patient outcomes?

Dr Rashdan: Biomarkers and genetic information really guide a treatment plan nowadays for lung cancer. What we need are faster and more reliable testing tools to be able to identify these biomarkers and genetic information.

Given the high costs associated with new NSCLC therapies, how do you balance clinical efficacy with cost effectiveness in your treatment recommendations?

Dr Rashdan: Balancing clinical efficacy with the cost-effectiveness and non-small cell lung cancer treatment recommendations requires a very careful and patient-centered approach. I typically review the specific genetic profile of the patient's cancer, and by doing that, I can tailor the treatment to target actionable mutations or biomarkers to maximize the efficacy and potentially reduce unnecessary costs associated with less effective treatments. I also take into account the patient's personal circumstances, such as insurance coverage and any available financial assistance programs, aiming to deliver high-quality care that is also sustainable. Typically, this would help ensure patients receive the best possible treatment within a framework of cost-conscious decision-making.

With potential breakthroughs in cell and gene therapies for NLCLC on the horizon, what strategies are you considering for managing the clinical and financial implications of these innovations?

Dr Rashdan: To manage the clinical and financial complexities of emerging therapies in non-small cell lung cancer, I prioritize a patient-centered approach. That's done by conducting a thorough molecular profile profiling and also considering clinical trial options. I tailor the treatment to individual patient needs, increasing the likelihood of effectiveness, and I also engage patients in shared decision-making to align treatment choices with their goals.

Financially, I focus on cost-benefit analysis and also look into insurance coverage. I typically utilize assistance programs that some of the companies offer to make these advanced therapies more accessible. It's important to be informed of the most recent research developments to be able to advocate for supportive policies that further enable me as a clinician to balance clinical innovation with sustainable and equitable patient care.

What are the emerging therapies or research developments in NSCLC that you are most optimistic about and how could they reshape treatment pathways?

Dr Rashdan: As I said, every few months we have a new targeted treatment, immunotherapy, of course, and also the combination of different targeted treatments, different immunotherapies, and the antibody-drug conjugates; all are very exciting treatment options that we will have. We'll see amazing outcomes from these different combinations of treatment as far as non-small cell lung cancer. We've already changed our practice multiple times in the last few years, and I think we will be changing our practice for better outcomes in the next few years.