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The Promise of Precision Medicine, Targeted Therapies & Immunotherapy: The Next Wave!

*April 2023*

The discussion then shifted to liquid and tissue biopsies. Liquid biopsies, which involve looking for abnormal DNA in the blood, are described as a great tool for patients whose tumors are shedding into their bloodstream. However, a negative result does not necessarily mean that there’s no mutation, as not all tumors release DNA. Tissue biopsies are still considered the ‘gold standard’, and can help determine the exact type of lung cancer, if enough tumor tissue is available. Dr. Neal also discussed the complexities of targeted therapies in the context of precision medicine for lung cancer treatment. He emphasized the importance of comprehensive diagnostic testing, including pathology reports and molecular profiling, to identify potential targets for drug therapy. The conversation further explored the rationale for prioritizing targeted therapies over chemotherapy in certain cases, based on clinical trial outcomes that demonstrated longer efficacy and better prevention of brain metastases. However, chemotherapy still plays a crucial role, especially when no targetable genes are found.

The discussion also highlighted the challenges in understanding resistance to immunotherapy and emphasizes the need for more clinical trials and biopsy data. Then the focus moved to the ‘next wave’ of lung cancer treatments. The discussion delved into the potential of targeted therapies, particularly those aimed at the Errb2 and HER2 genes, with a special mention of the FDA-approved Trastuzumab Deruxtecan (Enhertu), a drug that has shown high response rates in lung cancer. This drug represents an exciting new class of treatments known as antibody-drug conjugates (ADCs), dubbed “chemo 2.0”, which deliver highly toxic chemotherapy drugs directly to the cancer cells, potentially reducing side effects and increasing effectiveness. ADCs are also shown to have a ‘bystander killing’ effect, where neighboring cancer cells are affected. Another key area of focus in the conversation was the advent of cell therapy, specifically genetically engineered T-cells, which are being trained to target and kill cancer cells. While these therapies are usually introduced after standard care, experts are keen on investigating the possibility of moving these new therapies to the frontline, balancing the potential benefits against the side effects. The episode concluded by addressing the potential role of these new treatments in the lung cancer treatment timeline, noting that such therapies are currently typically introduced after standard of care has been administered, but as efficacy is proven out, they may be moved up to earlier in the treatment timeline. Watch here.