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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. E: SSRAMAL@emory.edu 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 therapeutic paradigm. 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. TOU CH MED ICA L MEDIA 77