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‘Wild West’: Cancer Drug Advances Are Creating Data Gaps

4:09 PM ETDeveloping

Health Desk

In Short: Oncologists are grappling with a new challenge as cancer drugs move from later to first-line treatments, creating gaps in evidence on what to prescribe when these drugs fail.

According to Mark Lewis, MD, a gastrointestinal oncologist at Intermountain Healthcare in Murray, Utah, the shift has made pembrolizumab the first and only drug some patients ever take.

However, Lewis noted, 'The slight nuance there is, what do you do if they progress on pembrolizumab. That’s a harder issue.'

Oncologists typically turn to a 'stronger' immunotherapy option, such as ipilimumab plus nivolumab, but Lewis emphasized, 'This is a bit of an evidence-free zone.'

Kathy D., a medical expert, acknowledged, 'It sounds crazy to complain that we’ve made improvements so quickly, but the problem is that treatment sequences are changing faster than the evidence needed to determine what should come next.'

Mark G., another expert, pointed out that even when there’s supporting evidence, the data can’t capture every nuance.

Melissa L., a medical professional, agreed, saying, 'We are definitely spoiled for choices now, but this is an uncomfortable place for oncologists and patients.'

In 2020, pembrolizumab became a first-line treatment for certain patients with metastatic colorectal cancer, highlighting the rapid pace of drug advances.

Miller, MD, a breast oncologist at Indiana University Health Simon Cancer Center in Indianapolis, noted, 'I can guarantee you, it will lead to significant heterogeneity in how those patients are managed.'

For patients without any 'clearly actionable resistance mutation,' oncologists might try the antibody-drug conjugate (ADC) trastuzumab deruxtecan (T-DXd), which is approved for previously treated HER2-mutant NSCLC.

The problem may be more common in some cancer types and drug classes, but the underlying challenge remains the same: treatment sequences are evolving faster than the evidence.

As oncologists and patients navigate these uncertainties, the field is acknowledging the emergence of a new group of patients for whom there are important management questions.

Oncologists have always dealt with uncertainty, but the rapid pace of drug approvals is creating new complexities.

What this adds

What's still developing

• “As we move forward, there are more nuances,” Kris said.

Sources

• Medscapelink