Oncogene-Positive Lung Cancer: What Therapy to Start?

This transcript has been edited for clarity.

I am Mark Kris from Memorial Sloan Kettering, speaking today on a recurring group of commentaries I've titled, "Reading Between the Studies."

There are many issues that we have to face in the day-to-day care of patients with lung cancers for which we do not have clinical trial data to guide us, and therefore, we have to make the best judgments we can based on the available data we have and the consensus among experts.

The topic I'd like to tackle today is: What is the optimal initial therapy for a patient with an oncogenic driver? Let's say you have identified a driver at the start of therapy. Do you start with a targeted therapy, or do you start with a more traditional or standard combination chemotherapy with or without a checkpoint inhibitor?

In terms of data, there are randomized trials for patients with EGFR-mutant disease and for ALKfusion–positive patients demonstrating that chemotherapy is not quite as good in terms of response and disease-free survival as targeted therapy. I think there is consensus — at least there is among the 21-member oncology group that that I work with — that for