What is the preferred second line, systemic therapy for NSCLC patients following first line chemoimmunotherapy?
How does the changing landscape of first-line treatment impact your decision making for second line therapy?
Answer from: Medical Oncologist at Academic Institution
This is as usual a quite complex question, and for a sophisticated audience such as theMednet readers, I always want to provide a nuanced answer; so here is what my preferred second line systemic therapy currently is:None.None.Still none…Indeed, now that chemo/immunotherapy has become the de ...
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Medical Oncologist at NYU Winthrop Hospital Keytruda/Ramrucimab: ASCO 2022
Answer from: Medical Oncologist at Academic Institution
The more things change, the more they stay the same. The simple answer is docetaxel or pemetrexed, depending upon prior therapy and histology. For a patient with a non-squamous carcinoma treated with carboplatin/pemetrexed/pembroluzimab, docetaxel is probably the correct choice. This is based upon ...
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Medical Oncologist at Medical Oncology and Hematology Associates-Des Moines Agreed. I have not seen much response with Ramucir...
Medical Oncologist at Virginia Cancer Spclsts PC Not sure if I would do a doublet. Look for clinica...
Answer from: Medical Oncologist at Community Practice
Other than clinical trials, patients (non-squamous) who received carbo/Taxol/BEV/Atezo, second-line therapy with pemetrexed second line is an option.Patients who received carbo/pem/Pembro (Adenocarcinoma or non-squamous) or patients who received carbo/nab-paclitaxel/Atezo (squamous), second line Doc...
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Medical Oncologist at St Lukes Cancer Care Assocs Why not Gemzar in 2nd line after carbo, abraxane, ...
Answer from: Medical Oncologist at Community Practice
This is a simple question with a complex answer. Second line is dependent on histology, tumor NGS, depth of response to chemoimmunotherapy, DoR, velocity of progression, site/sites of progression, availability of clinical trials, and patient's PS. If there is a potential target (NTRK or MET exon 14)...
Answer from: Medical Oncologist at Community Practice
Gandara et al. presented an abstract (#9001) at ASCO 2017 that looked at atezolizumab beyond progression (for transparency, I was an al.) Interestingly, over 50% of patients in the Oak study were treated beyond progression and over 50% had either stable disease or even responded. This was not purely...
Answer from: Medical Oncologist at Academic Institution
For patients with metastatic NSCLC without a targetable alteration who have progressed on first-line chemoimmunotherapy, I think the preferred second line therapy remains ramucirumab plus docetaxel, based on the REVEL study (Garon et al., PMID 24933332). But, as with the fragmentation by molecular a...
Answer from: Medical Oncologist at Community Practice
While many exciting agents are being tried in the post-chemo-IO setting for NSCLC, with some showing encouraging early signs of efficacy, as of now, the landscape of approved therapies is limited except for tumors where actionable driver mutations are present. For patients with targetable driver mut...
Answer from: Medical Oncologist at Community Practice
The emergence of molecular targeted therapies and immune checkpoint inhibitors as standard first-line treatments for non-small cell lung cancer (NSCLC), has led to a growing population of patients where the posed question becomes very relevant when molecular targeted therapies and immune checkpoint ...
Answer from: Medical Oncologist at Academic Institution
I am offering my patients access to clinical trials where I continue IO and change its partner: docetaxel/ramucirumab with pembrolizumab; vorolanib with nivolumab; Lung MAP. Don’t hesitate to reach out to me if you are considering one of these options for your patient.
Keytruda/Ramrucimab: ASCO 2022