The following article, written by Marjorie Velasquez, a Clinical Oncology Pharmacist at Oncology Analytics, is the fourth and final article of a four-part series on key trends and findings from the American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago May 31-June 4, 2019.

Lung cancer is caused by an abnormal overgrowth of cells in the lungs, which reduces a person’s ability to breathe effectively. Lung cancer is the leading cause of cancer-related death in both men and women, killing more men and women than breast, prostate, and colon cancer combined. According to the American Cancer Society, in 2019, there will be about 228,000 new cases of lung cancer and 142,000 deaths in the United States. Although anyone can develop lung cancer, cigarette smoking, and exposure to smoke and other toxic chemicals increases the likelihood of developing the condition.

There are two major types of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), with NSCLC accounting for about 85 percent of lung cancers. NSCLC is further divided into three subtypes: adenocarcinoma, the most common form of lung cancer; squamous, which accounts for 25 percent of all lung cancers; and large cell carcinoma, which accounts for about 10 percent of all NSCLC.

Walter Elias Disney (Walt Disney), the creator of Mickey Mouse, co-founder of Disneyland and Walt Disney World and a lifelong smoker, was diagnosed with lung cancer in November of 1966. Disney succumbed to the illness in December of 1966, just ten days after his 65th birthday. One of his daughters, Diane Disney Miller, was an advocate for the eradication of youth access to tobacco. Miller states, “lung cancer is one fatal disease that can be almost completely eradicated by lifestyle change.

At #ASCO2019, a multinational, double-blind, randomized Phase 3 study on the RELAY Trial, was presented, which included 449 patients with EGFR positive (+) metastatic NSCLC to evaluate the combination of two different types of targeted therapy drugs: erlotinib, an EGFR inhibitor, and ramucirumab, a VEGR inhibitor, versus placebo.

Targeted therapy works by targeting the cancer’s specific genes, proteins, or environment that contributes to cancer growth and survival without excessively damaging normal cells in the body. There are different types of targeted therapies that split into three broad categories. Some get into the cancer cell, disrupting its function, causing death. Some target the outside or surface of the cancer cell, and some target the cancer cells blood vessels, which supply oxygen, causing the cells to starve and die. Two types of targeted medications are monoclonal antibodies that target the vascular endothelial growth factor (VEGR) and epidermal growth factor receptor (EGFR) inhibitors. Both agents block the growth of cancer cells but in different ways, ultimately leading to cancer cell death.

Currently, no chemotherapy regimen is FDA-approved to block both EGFR and VEGR pathways. The thought is that blocking two pathways will enhance the anti-cancer effect in the body better than targeting one sole pathway. In the RELAY Trial, patients were randomized to receive erlotinib plus placebo or ramucirumab. Patients were able to receive treatment until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival, while secondary endpoints included safety, overall survival (OS), overall response rate (ORR), and duration of response (DOR). At the time of analysis, erlotinib plus ramucirumab significantly prolonged progression-free survival (PFS) versus placebo (median PFS 19.4 months versus 12.4 months). The ORRs were 76% in the erlotinib plus ramucirumab group versus 75% in the erlotinib plus placebo group. The OS data had not fully matured at the time of data cutoff on January 23, 2019. Although the findings from the trial are early, initial results suggest the combination of erlotinib and ramucirumab may be a new treatment option for EGFR (+) patients.

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