Dr. Rami Manochakian on Unanswered Questions in Lung Cancer

Rami Manochakian, MD, FASCO, of the Mayo Clinic, Florida, who served as the lung cancer panelist during Advancements in Oncology, discusses what oncologists need to know about advances in lung cancer treatment and the latest data.

With so many updates and new treatment strategies for lung cancer, it can be difficult for specialists and community oncologists alike to navigate the different options, he said.

However, this is a “good problem,” he noted.

“We have multiple treatment options that are now available… but they’re not compared with each other,” Dr. Manochakian said. “And when we’ve tried to sequence them, we start coming [to the question of]: ‘Which path is better?’”

For example, questions remain about the optimal sequencing of targeted treatments for patients with non-small cell lung cancer.

“In the ALK-[positive setting], do we do lorlatinib first, or not? Or another ALK inhibitor? In the EGFR world, how do you sequence your treatment?” Dr. Manochakian asked.

He spoke about the type of research and clinical trials that may be able to address the major unanswered questions in lung cancer.

“What could answer [these questions] is potentially a trial comparing some of these options,” Dr. Manochakian said. “But we know this is difficult, especially to run these trials for so long and when you’re also trying to get an overall survival [end point] in some of these trials, which would be probably the best primary end point, but that’s not always very feasible and doable in these trials.”

Despite these challenges in addressing the unanswered questions, it’s “an exciting era,” Dr. Manochakian said, noting that the many new trials examining biomarkers may help provide guidance about which treatment path is best for a particular patient.