How to Manage TKI Progression: Nuances of Care and Updates on T790M-directed Therapies

Chapter 5

In this video, Benjamin Levy, MD, medical director of the thoracic oncology program at Mount Sinai Health Systems in New York, discusses the management of patients whose disease is resistant to tyrosine kinase inhibitors (TKIs). Patients with advanced, epidermal growth factor receptor (EGFR)-positive lung cancer should be offered a first- or second-generation TKI. These patients will, however, eventually become resistant to these drugs, at which point a treatment decision can be hard to identify. Dr Levy discusses 3 common scenarios of this kind, and offers guidance on how to prescribe treatment for each.

Chapter 1

Chemotherapeutic and Targeted Strategies for Squamous Cell Carcinoma

In this video, Benjamin Levy, MD, medical director of the thoracic oncology program at Mount Sinai Health Systems in New York, discusses potential chemotherapies and targeted therapies for squamous cell lung cancer, for which there are no U.S. Food and Drug Administration-approved targeted therapies. Treating this disease successfully requires proactive treatment and diagnosis; new data suggest a number of therapy combinations that may be effective. Chemotherapy treatment combinations in this setting, and more recently, histology-directed treatments, are shown to provide survival benefits.

Chapter 2

How to Treat Patients Without an Actionable Mutation

In this video, Benjamin Levy, MD, medical director of the thoracic oncology program at Mount Sinai Health Systems in New York, discusses the treatment of patients in whom there are no targetable mutations. Adenocarcinoma does not always have an actionable mutation such as epidermal growth factor receptor (EGFR). For patients without known, treatable mutations, the “default” treatment is chemotherapy, which can be very effective. Dr Levy discusses the potential chemotherapy options for this patient population.

Chapter 3

ALK-directed Therapies in Advanced Stage Lung Cancer: Current State and Future Directions

In this video, Benjamin Levy, MD, medical director of the thoracic oncology program at Mount Sinai Health Systems in New York, discusses anaplastic lymphoma kinase (ALK) rearrangements, which occur in 3% to 5% of all cases of non-small cell lung cancer. The presence of these rearrangements depends, however, on the age and smoking behaviors of the individual patient. Crizotinib is the standard therapy for patients with this rearrangement, which does not necessarily improve overall survival. Finding treatments for patients who become resistant to this therapy can also be a challenge.

Chapter 4

Is There an Optimal EGFR TKI? Examining the Evidence

In this video, Benjamin Levy, MD, medical director of the thoracic oncology program at Mount Sinai Health Systems in New York, discusses how epidermal growth factor receptor (EGFR) mutations play an important role in lung cancer. Genomic tests are becoming increasingly important in lung cancer care to appropriately target cancers for individual patients; targeted therapies that replace chemotherapy for EGFR-positive cancers improve responses and quality of life. Here Dr Levy discusses several studies comparing and contrasting the efficacy of targeted mutations in this setting.

Chapter 6

Liquid Biopsies in Lung Cancer: The Future Is Now

In this video, Benjamin Levy, MD, medical director of the thoracic oncology program at Mount Sinai Health Systems in New York, discusses liquid biopsies. Before liquid biopsies, tissue biopsies were used to identify prognostic biomarkers. But tissue biopsies are invasive and take time, whereas a liquid biopsy, which is a minimally invasive blood test, can reveal a lot about a lung tumor’s genomic makeup. Dr Levy describes how these tests, which do not test for circulating tumor cells, but instead for circulating tumor DNA, can be analyzed with a simple assay.

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