Spotlight from JADPRO Live 2023

Metastatic NSCLC: Advancing Precision-Targeted Treatment

Sarah E. Sagorsky, MPAS, PA-C, of the Sidney Kimmel Cancer Center on the Bayview campus, discusses a presentation that reviewed new molecular-targeted treatment options for patients with metastatic non-small cell lung cancer, related updates to clinical practice guidelines, the implications of biomarker testing, and evidence-based best practices for monitoring and managing adverse events associated with these therapies.


Sarah Sagorsky:

I just recently attended the non-small cell lung cancer treatment paradigm symposium at JADPRO. Lung cancer is the second most common diagnosed cancer and the leading cause of cancer-related deaths. The NCCN guidelines recommend next generation sequencing for all non-small cell lung cancer patients that have non-squamous, and as well as some squamous malignancies. It's imperative to do next generation sequencing on all non-small cell lung cancer patients, non-squamous, and even some squamous cell patients. It's important to also wait for the NGS reports to come back. First and foremost, we want to make sure that patients get the most appropriate first-line therapy, and it's also important to wait because there could be potential toxicities related to therapy. For instance, if a patient has an EGFR mutation and they were given immunotherapy and you didn't know the patient had a mutation, and then ultimately they were able to receive a TKI, the patient is at higher risk for toxicity, including pneumonitis.

It is imperative to look at NGS reports prior to the second-line setting because if patients have a KRAS mutated non-small cell lung cancer, there are oral therapies that are available to treat these KRAS non-small cell lung cancer patients. As an advanced practice provider, I think it's also very important to monitor the patient's side effects while on therapy and to educate them prior to even starting, because we want patients to derive clinical benefit and by managing the toxicities, patients are able to remain on these therapies and derive benefit longer, and they're able to continuously live their lives with advanced non-small cell lung cancer.

I think our patients have never had more options to treat their non-small cell lung cancer than we have now. So biomarker testing is important. It's important in the first-line setting and the second-line setting. One of the things that the presenter talked about is how advanced practice providers play a pivotal role in managing a wide range of toxicities that our patients may experience, and it's important to educate the patients on the potential toxicities that may occur, and to utilize all of the resources that we have as advanced practice providers to keep the patients on these oral oncolytics with good supportive care medications and minimal disruptions in their treatment so that they will derive clinical benefit.

Something that I learned that I'll take back to clinical practice is the advancement in precision medicine in the adjuvant non-small cell lung cancer space. I think it's important to educate patients as well as advanced practice providers on the importance of biomarker testing for newly diagnosed patients, as well as when patients progress. But I think that all of the patients want to start treatment as soon as possible, but it is imperative that we wait for that testing to come back so the patients get the most efficacious option in the first-line setting and beyond.