Emory University

Nov 24, 2023

November 24, 2023 Video Experts in breast, lung, and gastric malignancies provide insights on multidisciplinary care in oncology and educating community specialists. Sponsored in part by Daiichi Sankyo. Content independently developed by OncLive®. Transcript: Benjamin P. Levy, MD: How do we communicate this information to the community out there? We're the ones front and center in the academic world. Is there a message here to the community? I guess in the breast [cancer] world, they're pretty familiar with these ADCs [antibody-drug conjugates]. I think in the lung [cancer] world, they're not. HER2 ADC just got approved a year and a half ago for lung [cancer] and we're still not doing a good job identifying HER2 exon 20 mutations in lung cancer. We're woefully undergenotyping patients. So, I'm just curious, is there a message, is there an APP [advanced practice provider] role here communicating to those out practicing in the community? Or is it the physician’s role to say this is what's going on? Maybe we'll start with Kevin [Dr Kalinsky]. In breast [cancer], is there a gap between what's known about ADCs in institutions like Emory [Winship Cancer Institute of Emory University in Atlanta, Georgia] vs what's happening out there? Or do you guys have it sorted out? Kevin Kalinsky, MD, MS: I will say, and this is an anecdotal comment, I feel like our community colleagues are often sending in NGS [next-generation sequencing] frequently, even maybe more frequently than what we sometimes do at academic centers. I don't have any specific data that I can point to; this is more of a feeling. I do think that I am seeing utilization of these ADCs. I'll make one breast cancer- specific comment for the ER+ [estrogen receptor–positive] HER2 low: The common sequence is trastuzumab deruxtecan and then sacituzumab govitecan and it's the reverse in the ER- [estrogen receptor–negative] setting. I will say the only thing I've seen with community colleagues is just maybe some differences in terms of the sequencing of the ADCs. But for us, we really don't have much data about sequencing from one ADC to the other if patients get a topoisomerase inhibitor payload and then they sequence to a different ADC with a different target but the same payload. We have very little data about efficacy at the time of sequencing. So, what I also had just mentioned in terms of our means of how we think aboutsequencing ADCs isjust based upon which study had the largest population of patients to determine that, not actually based upon much data of efficacy post ADC. Benjamin P. Levy, MD: Ben [Dr Musher] and Michal [Segal], [do you have] any messages? You've got one drug. Great results. Third line gastric. Is this already being adopted in the community? Is this a no-brainer? Is there anything that needs to be shared? I think the community around here has got it and they oftentimes educate us on some things. I don't know if there's an opportunity to educate the community. I know the New York City area very well, having lived there for 12 years, and so I understand the community around there. But maybe we can start with Ben and then Michal, are there any opportunities that you see here? Benjamin L. Musher, MD: It's the guidelines. I think most people go by guidelines. They know when new drugs get approved. We don't have multiple ADCs approved and there aren't these subtleties of which lines to use them in. I think second line vs third line, I would love to see more people using it in the second line… . These drugs, for whatever reason, don't work in the neoadjuvant arrangement setting for gastric cancer. At least they haven't thus far. And that might just be an issue with using an antibody as opposed to something more potent like an ADC. Publicizing clinical trials is always going to be important, but I don't really have a great sense of how to do this aside from just getting second opinions and educating that way and spreading the word throughout the community and again using guidelines, which are pretty clear for this. We really have one for the time being, so ours is fairly simple. Michal, do you have any other ideas? Benjamin P. Levy, MD: Yes, Michal, your thoughts? Michal F. Segal, RN: NCCN [the National Comprehensive Cancer Network] is great but I feel like for nonclinical people it's extremely confusing. I sometimes do refer patients to that website, in general, to just look through the patient resources. But I agree [for] gastroesophageal orphan diseases, we don't have much [information] there. Hopefully, patients when they're getting diagnosed are googling and getting some [help]. But what I wanted to say before was touched upon with the heterogeneity of disease. I think upfront if we could educate patients to be very proactive about their tissue, about biomarkers, making sure they get all their reports, addendums, and any additional staining, because we can help them and guide them once we see them. But it certainly is going to add time if they aren't on top of it already. It's hard for [people with] the orphan diseases [because] there's that not many patient resources. Hopefully, those patients are being more savvy. Benjamin P. Levy, MD: Rasheda [Persinger], and then Kayla [Freeman], do you have any final thoughts on this? I know for lung [cancer] there's always an opportunity on just how complex this can get with all the biomarker testing. Rasheda, your quick thoughts on this? Rasheda Persinger, MSN, AGNP-C, AOCNP: I think to my APP community, who aren’t just seeing lung [cancer] but a plethora of other diseases, even for me, it's overwhelming. As an APP who is fortunate to specialize in the thoracic space, I usually say I've worked in a community practice aspect as well. Don't be afraid to make a little cheat sheet. Put it in your pocket or your lab coat as it relates to adverse effects, what to ask, what to look for, just a little go-to sheet. Because in lung cancer, there is always something that's been newly indicated, I almost want to say, on a week-to-week basis. It’s kind of hard to just commit all of that to memory. One takeaway is, whatever works for you so you can assess these patients appropriately, use it. One thing is maybe just having a little cheat sheet to put in your pocket. Benjamin P. Levy, MD: Kayla, any other thoughts on this? I think everyone has mentioned very similar things, but anything from your perspective to help communicate the management of and the expectations from these drugs? Kayla Freeman, DNP, APRN, FNP-C: I think at Emory, we have good educational handouts on drugs in particular. I'm utilizing those heavily, even if I've seen a patient and have seen a drug several times. I'm also giving it to the patients so that they have a good understanding as well. And I'm learning from patients. They may have new adverse effects and things they're experiencing. I’m kind of keeping [those observations] in my back pocket. I think it's just heavily utilizing resources as this is the ever-changing space that we're working in. Benjamin P. Levy, MD: Yes, great points. Transcript is AI-generated and edited for clarity and readability. Related Videos