Unmet Needs in the Treatment and Management of Non–Small Cell Lung Cancer

In this interview, Alexander I. Spira, MD, PhD, Virginia Cancer Specialists, discusses significant unmet needs in the treatment and management of non–small cell lung cancer (NSCLC) and the rise of EGFR mutations in patients with lung cancer.

Please introduce yourself by stating your name, title, organization, and professional experience.

I'm Dr Alex Spira. I'm with Virginia Cancer Specialists and US Oncology. I've been a medical oncologist for 20 years, and now I specialize mostly in lung cancer and clinical trial patients.

What do you see as the most significant unmet needs in the treatment and management of non–small cell lung cancer (NSCLC)?

The biggest needs in the treatment and management of NSCL are that we need better drugs. No matter what we say, our five-year survival and two-year survival is not where we need it to be right now. So, we need better drugs and better treatments for our patients is the bottom line. Despite a lot of headway, there's always work to be done.

How do current treatment options fall short in addressing these unmet needs when it comes to payer coverage (eg, missing real-world data, lack of clinical trial evidence)?

The current treatment options for NSCLC are decent. However, in lung cancer once you get to the second round of treatment for patients with stage 4 disease, there are not great treatments there, and that's one of the areas where we run into trouble.

One of the big issues we have is that when there's data but not an US Food and Drug Administration  (FDA) approval, it's often hard to use drugs or get them for off-label use. So, we need more real-world data. We need more options for our patients where it's kind of in that neverland where the trials haven't been done. Once there's evidence, there's often a long gap either before a drug is approved or even if it's an approved drug for a different cause. And cost is important too. We need to look closely at cost per quality adjusted life because there's a lot of very expensive drugs and they are limitations.

As you may know, lung cancers continue to remain the most common forms of cancers and are also considered the deadliest in the US. According to data published by the American Cancer Society, more than ¼ of patients with NSCLC carry an EGFR mutation. Are you aware of the growing prominence of EGFR mutations in patients with lung cancer, in NSCLC specifically? What are your thoughts on this?

EGFR-mutated NSCLC is a well understood disease, but we continue to need more treatments. It's more common, especially in the non-smoking population and even in smokers. So, we're noticing the mutations more and there are a lot of treatments. But again, we still need better treatments for this patient population.

According to data published in Lung Cancer, approximately 1 in 5 patients with NSCLC survive 5 years. As EGFR mutations become more commonly associated with NSCLC and influences overall survival of patients, what coverage opportunities do you see to better address the needs of patients with these mutations? What can providers and researchers do to support evidence to address this unmet need in the NSCLC patient population?

We need to ensure that these drugs are paid for and the patients can afford them. Some of them are oral and some of them are IV. There are two new drugs that have been approved recently—amivantamab and lasertum—and these drugs are expensive. We need to ensure our patients have access to drugs, which also means that they can afford to take it and their co-pays are reasonable, and especially when mixing IV and oral therapies. It can be hard. Getting more real-world data showing that we're not just improving cancer treatment but we're also improving outcomes and how patients are feeling will be important. So, secondary studies are also important.