Advancing Treatments in Resectable Non-Small Cell Lung Cancer

Major advances in treatment for certain patients with resectable non-small cell lung cancer (NSCLC), including the approval of Tecentriq^® (atezolizumab) in 2021, have helped reshape the clinical landscape.^1,2 To understand the impact of these game-changing treatments, we sat down with Dr. Girish Kunapareddy for a conversation about the evolution of care.

Dr. Girish Kunapareddy

How have advances in lung cancer treatment changed your practice?

The changes have been remarkable. The advances were first felt in advanced lung cancer with the introduction of immunotherapies and targeted therapies. And now we’ve seen momentum as some of those treatments are expanding into earlier stages, including resectable disease.

This evolution in the adjuvant setting started with the approval of EGFR-targeted therapy, followed shortly thereafter by Tecentriq immunotherapy. Since then, other immunotherapies have been approved, giving patients with resectable NSCLC even more options. With these powerful tools available, it’s become more important than ever that we aim to eradicate even microscopic traces of the disease to help improve outcomes after surgery.

Has this changed your conversations with patients?

Absolutely. As more treatment options have become available, I’m able to have more optimistic conversations with my patients. In resectable NSCLC specifically, our conversation is focused on being aggressive to help prevent the disease from coming back after surgery. Whereas several years ago, chemotherapy was our only treatment option in this setting, today we have a growing number of therapies that may further reduce the risk of recurrence. For example, if the patient’s cancer stage II-IIIA NSCLC is positive for PD-L1, we may discuss Tecentriq as a post-surgery option.²

How do you initiate discussions about biomarker testing with your patients?

It’s crucial that every patient gets a personalized treatment plan, and biomarker testing is a critical step to ensuring that plan is individualized. For advanced lung cancer, that may mean next-generation sequencing for all relevant genetic biomarkers and PD-L1 testing. For resectable disease, specific testing for ALK, EGFR, and PD-L1 is essential to match patients with an appropriate treatment.

I start my care discussions with patients by explaining how NSCLC treatments have changed and how essential biomarker testing is to ensure their care is personalized for their cancer. I’ll say, “Not all treatment options are the same. The science and technology are ever-evolving around how we treat NSCLC, so we don't just pick a one-size-fits-all treatment option anymore. We want to be much more individualized and pick the treatment options for this particular cancer and for you.” And I think patients understand that and appreciate it.

Many patients don’t get tested for recommended biomarkers. How do you think this can be improved?

It’s really concerning that so many lung cancer patients still don’t receive biomarker testing. In fact, one study found that less than half of patients with metastatic NSCLC are tested for all of five key biomarkers associated with the disease.³ I’ve seen some improvement in the last four or five years, but it's not enough.

One area where I believe we can improve is knowledge sharing. It's critical that all relevant information, including orders for biomarker tests and what to do with those results, is shared across a patient’s entire care team, not only within the same specialty but across specialties. Multidisciplinary tumor boards are a great system that could bring together oncology, radiology, pathology, pulmonology, surgery, geneticists, and healthcare navigators to help treat the whole patient and their cancer.

In my practice, we are also working on a care pathway map of a patient’s journey from the time of diagnosis all the way to survivorship. It details each step, including biomarker testing, and helps intertwine all of the specialties involved in that patient’s care. So even a primary care physician can look and say, “Okay, there’s a delay getting my patient into medical oncology, so I should go ahead and order a PET scan.” Resources like that could have a great impact on quality of care to help ensure all patients receive the best possible diagnostics and appropriate treatment.

Indication and Important Safety Information

TECENTRIQ is a medicine that may be used alone to treat adults with a type of lung cancer called non-small cell lung cancer (NSCLC), to help prevent their lung cancer from coming back after their tumor has been removed by surgery and they have received platinum-based chemotherapy, when they have stage 2 to 3A NSCLC, and also when their cancer tests positive for “PD-L1”.

It is not known if Tecentriq is safe and effective when used in children for the treatment of NSCLC.

What is the most important information about Tecentriq?

Tecentriq can cause the immune system to attack normal organs and tissues in any area of the body and can affect the way they work. These problems can sometimes become severe or life threatening and can lead to death. Patients can have more than one of these problems at the same time. These problems may happen anytime during their treatment or even after their treatment has ended.

Patients should call or see their healthcare provider right away if they develop any new or worse signs or symptoms, including:

Lung problems

• cough
• shortness of breath
• chest pain

Intestinal problems

• diarrhea (loose stools) or more frequent bowel movements than usual
• stools that are black, tarry, sticky, or have blood or mucus
• severe stomach-area (abdomen) pain or tenderness

Liver problems

• yellowing of the skin or the whites of the eyes
• severe nausea or vomiting
• pain on the right side of their stomach area (abdomen)
• dark urine (tea colored)
• bleeding or bruising more easily than normal

Hormone gland problems

• headaches that will not go away or unusual headaches
• eye sensitivity to light
• eye problems
• rapid heartbeat
• increased sweating
• extreme tiredness
• weight gain or weight loss
• feeling more hungry or thirsty than usual
• urinating more often than usual
• hair loss
• feeling cold
• constipation
• their voice gets deeper
• dizziness or fainting
• changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness

Kidney problems

• decrease in their amount of urine
• blood in their urine
• swelling of their ankles
• loss of appetite

Skin problems

• rash
• itching
• skin blistering or peeling
• painful sores or ulcers in mouth or nose, throat, or genital area
• fever or flu-like symptoms
• swollen lymph nodes

Problems can also happen in other organs.

These are not all of the signs and symptoms of immune system problems that can happen with Tecentriq. Patients should call or see their healthcare provider right away for any new or worse signs or symptoms, including:

• Chest pain, irregular heartbeat, shortness of breath, or swelling of ankles
• Confusion, sleepiness, memory problems, changes in mood or behavior, stiff neck, balance problems, tingling or numbness of the arms or legs
• Double vision, blurry vision, sensitivity to light, eye pain, changes in eyesight
• Persistent or severe muscle pain or weakness, muscle cramps
• Low red blood cells, bruising

Infusion reactions that can sometimes be severe or life-threatening. Signs and symptoms of infusion reactions may include:

• chills or shaking
• itching or rash
• flushing
• shortness of breath or wheezing
• dizziness
• feeling like passing out
• fever
• back or neck pain

Complications, including graft-versus-host disease (GVHD), in people who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be serious and can lead to death. These complications may happen if patients undergo transplantation either before or after being treated with Tecentriq. A healthcare provider will monitor for these complications.

Getting medical treatment right away may help keep these problems from becoming more serious. A healthcare provider will check patients for these problems during their treatment with Tecentriq. A healthcare provider may treat patients with corticosteroid or hormone replacement medicines. A healthcare provider may also need to delay or completely stop treatment with Tecentriq if patients have severe side effects.

Before receiving Tecentriq, patients should tell their healthcare provider about all of their medical conditions, including if they:

• have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus
• have received an organ transplant
• have received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic)
• have received radiation treatment to their chest area
• have a condition that affects their nervous system, such as myasthenia gravis or Guillain-Barré syndrome
• are pregnant or plan to become pregnant. Tecentriq can harm an unborn baby. Patients should tell their healthcare provider right away if they become pregnant or think they may be pregnant during treatment with Tecentriq. Females who are able to become pregnant:
  • A healthcare provider should do a pregnancy test before they start treatment with Tecentriq
  • They should use an effective method of birth control during their treatment and for at least 5 months after the last dose of Tecentriq
• are breastfeeding or plan to breastfeed. It is not known if Tecentriq passes into the breast milk. Patients should not breastfeed during treatment and for at least 5 months after the last dose of Tecentriq

Patients should tell their healthcare provider about all the medicines they take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

The most common side effects of Tecentriq when used alone include:

• feeling tired or weak
• decreased appetite
• nausea
• cough
• shortness of breath

Tecentriq may cause fertility problems in females, which may affect the ability to have children. Patients should talk to their healthcare provider if they have concerns about fertility.

These are not all the possible side effects of Tecentriq. Patients should ask their healthcare provider or pharmacist for more information about the benefits and side effects of Tecentriq.

Report side effects to the FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch.

Report side effects to Genentech at 1-888-835-2555.

Please see full Prescribing Information for additional Safety Information.

M-US-00022079(v1.0)

References:

1. National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ®)–Health Professional Version. Available online at: https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq
2. National Cancer Institute. Advances in Lung Cancer Research. Available online at: https://www.cancer.gov/types/lung/research#:~:text=Two%20immunotherapy%20drugs%2C%20atezolizumab%20
3. Robert NJ, et al. Biomarker testing and tissue journey among patients with metastatic non-small cell lung cancer receiving first-line therapy in The US Oncology Network. Lung Cancer. 166 (2022), pp. 197-204.