Expert Interviews

Panelists discuss how the choice of frontline therapy influences future treatment options by requiring strategic planning for progression, with emphasis on using radiation for oligoprogressive disease to continue effective treatments, repeating genomic testing to assess resistance patterns, considering clinical trials, and utilizing multidisciplinary approaches including surgery for oligoresidual disease to potentially achieve curative outcomes in selected patients.

Panelists discuss how multidisciplinary collaboration with subspecialists, particularly dermatologists, is essential for managing cutaneous and other treatment toxicities associated with combination therapies like amivantamab and tyrosine kinase inhibitors, as dermatologists have become increasingly familiar with oncology-related toxicities and can provide specialized interventions when standard preventive measures fail, with access to academic medical centers offering additional expertise for complex cases.

Panelists discuss how the availability of subcutaneous amivantamab could be a game changer for clinical practice by lowering the threshold for using amivantamab plus lazertinib combination therapy, as it would decrease infusion-related reactions, reduce VTE risk, improve infusion center efficiency, and make the regimen more appealing to patients by offering an injection plus pill vs multiple intravenous chemotherapy medications plus pill.

Panelists discuss how toxicity discussions with patients must emphasize different adverse effects for each combination therapy, with osimertinib plus chemotherapy requiring focus on fatigue, cytopenias, and dermatologic toxicity, while amivantamab plus lazertinib requires discussion of infusion reactions, venous thromboembolism prophylaxis, and skin toxicities, though they acknowledge that complex prophylactic regimens can be challenging for patients with lower health literacy and may involve significant financial burden.

Panelists discuss how combination therapies create additional time and financial burdens compared with osimertinib monotherapy, with treatment requiring more frequent visits (every 3 weeks for FLAURA2, weekly then biweekly for amivantamab), and while some clinicians follow trial protocols to continue maintenance pemetrexed, others have a lower threshold to discontinue it to reduce time toxicity and improve quality of life, balancing patient preferences with potential treatment benefits.

Panelists discuss how the projected 1-year overall survival benefit from the amivantamab plus lazertinib combination in the MARIPOSA trial represents impressive and meaningful progress for patients with incurable disease, with the hazard ratio of 0.75 being a significant deciding factor for many patients, though they acknowledge the complexity of interpreting this benefit given the lack of crossover in the trial and uncertainty about optimal sequencing strategies.

Panelists discuss how maintaining quality of life must be balanced with efficacy in metastatic lung cancer patients, emphasizing the importance of early intervention for adverse events through patient education, frequent follow-up visits (including day 8 and day 15 visits), close monitoring with laboratory checks, and proactive communication via nursing and pharmacy teams to ensure patients can stay on therapy longer and derive maximum clinical benefit.

Panelists discuss how resistance mechanisms influence frontline therapy selection, with clinicians considering comutational status, brain and liver involvement, and disease burden when choosing combination therapies, while acknowledging the chess-like strategic thinking required to balance optimal progression-free survival with future treatment options, especially given that 25% to 30% of patients may not receive second-line therapy.

Panelists discuss how choosing between the 2 combination therapies (osimertinib plus chemotherapy vs amivantamab plus lazertinib) involves considerations of familiarity and comfort level, with many clinicians favoring the more familiar chemotherapy plus osimertinib approach while acknowledging that having different mechanistic options provides valuable sequencing flexibility for future treatment decisions.

Panelists discuss how patient preferences for EGFR-mutant mNSCLC treatment vary widely based on medical literacy, information-seeking behavior, and prior experiences, with clinicians emphasizing the importance of shared decision-making, understanding patients’ reasoning behind their preferences, and meeting patients where they are in their knowledge and comfort level to formulate treatment plans that align with their goals of care.

Ongoing studies aim to combine base immunotherapy regimens with novel agents to potentially improve outcomes among patients with kidney cancer.

Investigators have found a way to reduce liver and biliary toxicity when targeting the molecule CAIX in patients with clear cell renal cell carcinoma.

Panelists discuss how treatment decisions between osimertinib monotherapy and combination therapy should be individualized based on patient factors including performance status, medical comorbidities, frailty, age, patient preferences for quality of life vs aggressive treatment, and genomic features such as comutations or resistance mechanisms, with shared decision-making playing a crucial role given the incurable nature of the disease.

Neoantigen-targeting vaccines resulted in an absence of recurrence in 9 patients with high-risk kidney cancer, according to David A. Braun, MD, PhD.

Panelists discuss how combination therapy with osimertinib plus chemotherapy or amivantamab plus lazertinib is being evaluated as a potential new frontline treatment standard for EGFR-mutant metastatic NSCLC, with treatment decisions requiring individualized approaches based on patient characteristics, disease burden, comorbidities, and quality of life considerations rather than a universal preferred regimen.

The Kidney Cancer Research Consortium may allow collaborators to form more mechanistic and scientifically driven efforts in the field.

Wayne A. Marasco, MD, PhD, stated that by targeting 2 molecules instead of 1, higher levels of tumor cell killing can be achieved in patients with clear cell renal cell carcinoma.

Leading experts in the breast cancer field highlight the use of CDK4/6 inhibitors, antibody-drug conjugates, and other treatment modalities.

Panelists discuss the need for consolidation and maintenance strategies following chimeric antigen receptor (CAR) T-cell therapy in patients with high-risk multiple myeloma, highlighting emerging real-world and clinical evidence supporting the use of agents like lenalidomide and bispecific antibodies to extend disease control and improve outcomes in those with historically shorter remissions.

Panelists discuss real-world evidence showing that chimeric antigen receptor (CAR) T-cell therapy is safe and effective in traditionally excluded populations with multiple myeloma, including those with comorbidities or central nervous system (CNS) involvement, emphasizing the role of multidisciplinary care, proactive toxicity management, and growing confidence in extending access to high-risk patients.