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Expert Interview Lung Cancer
Targeted and Immune Therapies in Non-small
Cell Lung Cancer—Latest Advances
An Expert Interview with Suresh S Ramalingam
Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, US
Suresh S Ramalingham
Suresh S Ramalingam, MD, is certified by the American Board of Internal Medicine in Internal Medicine and Medical Oncology and is
an active member of the American Society of Clinical Oncology, the American Association for Cancer Research, and the International
Association of Lung Cancer Study. Dr Ramalingam plays an active role in the Eastern Cooperative Oncology Group as the Chair of the
Thoracic Malignancies Committee and as the Deputy Chair of Therapeutics Studies. Dr Ramalingam serves on several international,
national and institutional committees. Starting July 2017, he will be a member of the Medical Oncology Board Exam Committee for the
American Board of Internal Medicine. He is also currently a recipient of peer-reviewed grants from the National Cancer Institute.
Keywords Immune therapies, NSCLC, EGFR
mutation, anti-PDL1, pembrolizumab
Disclosure: Suresh S Ramalingham has nothing to declare
in relation to this article. No funding was received in the
publication of this article. This is an expert opinion piece
and has not been submitted to external peer reviewers.
Authorship: All named authors meet the International
Committee of Medical Journal Editors (ICMJE) criteria
for authorship of this manuscript, take responsibility
for the integrity of the work as a whole, and have
given final approval to the version to be published.
Open Access: This article is published under the
Creative Commons Attribution Noncommercial License,
which permits any noncommercial use, distribution,
adaptation, and reproduction provided the original
author(s) and source are given appropriate credit.
Received: August 30, 2017
Published Online: November 17, 2017
Citation: Oncology & Hematology Review, 13(2):77–8
Corresponding Author: Suresh S Ramalingham,
Winship at Emory University Hospital Midtown,
550 Peachtree Street, NE Atlanta, Georgia 30308, US.
I n recent years the treatment landscape of non-small cell lung cancer (NSCLC) has been transformed.
The emergence of therapies targeting specific genetic alterations, such as epidermal growth
factor (EGFR) mutations, as well as immune checkpoint inhibitors targeting the transmembrane
protein programmed death-1 (PD1) and its ligand (PDL1), has increased the therapeutic options for
patients with NSCLC. In an expert interview, Suresh S Ramalingam discusses recent advances in
targeted and immune therapy and considers the role of chemotherapy within this rapidly evolving
Q: Following the emergence of targeted therapies in non-small
cell lung cancer, how useful is the testing of circulating
tumor-derived DNA for EGFR mutation testing?
Testing peripheral blood for actionable mutations represents a major advance in the management of
lung cancer. It is now possible to understand mechanisms of resistance to EGFR-targeted therapies.
Recently, the Food and Drug Administration (FDA) approved a plasma based test for detection of EGFR
mutation in patients with newly-diagnosed advanced NSCLC as a companion-diagnostic to treatment
with erlotinib. In addition, plasma testing for T790M is associated with high sensitivity and specificity,
and can also be used to support the use of osimertinib, a T790M inhibitor for patients with acquired
resistance to EGFR tyrosine kinase inhibitors. In addition, plasma testing also provides avenues for
research on longitudinal monitoring for resistance, and early detection of cancer recurrence.
Q: What do you see as the major challenges in targeted therapy in
EGFR mutation positive non-small cell lung cancer?
Every patient treated with an EGFR inhibitor develops acquired resistance. As our understanding of
these mechanisms have improved, new targeted therapies such as osimertinib have been developed.
It is now possible to administer osimertinib as front-line therapy and avoid the emergence of T790M
mechanisms of resistance. The next steps will be to understand potential mechanisms of resistance
to third generation EGFR inhibitors and develop strategies to overcome them. In addition, combining
third generation EGFR inhibitors with other molecularly targeted agents to extend the benefits to
patients with EGFR mutations remains an important priority.
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