Lung-MAP, a precision medicine umbrella trial for patients with advanced non-small cell lung cancer (NSCLC), has expanded genetic screening options for patients who enroll in this clinical trial of biomarker-driven therapies. The Friends of Cancer Research (Friends) hosted a webinar to explore how Lung-MAP is accelerating lung cancer discovery.
“Lung-MAP has always stood out for its ability to evolve,” said Ryan Hohman, JD, Vice President for Public Affairs at Friends and moderator of one of the webinar’s panels. Referred to as Lung-MAP 3.0, the trial will allow enrollees to be matched to a targeted therapy based on the results of their prior genetic testing, rather than having to submit new tumor or blood samples for testing.
This expanded biomarker screening process will help make Lung-MAP studies more accessible to patients at a wider variety of clinical sites, including smaller community-based sites near where patients live. The list of approved next-generation sequencing genomic tests has now grown to more than 40 and continues to expand.
“We are represented across the U.S. This is a huge benefit of Lung-MAP in terms of accessibility for patients,” said Karen Reckamp, MD, MS, Lung-MAP Principal Investigator and Director of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center.
The purpose of Lung-MAP is to quickly and efficiently test new treatments for NSCLC, which makes up about 85% of all U.S. lung cancer diagnoses. Lung-MAP is a collaborative public-private partnership that includes the National Cancer Institute (NCI); the NCI-funded National Clinical Trials Network (NCTN), including the SWOG Cancer Research Network; Friends; the Foundation for the National Institutes of Health (FNIH); Foundation Medicine; pharmaceutical companies that provide their drugs; and lung cancer advocacy organizations. “This has been a successful public-private partnership,” said Reckamp.
Like Reckamp, Bryan Faller, MD, praised the increased accessibility of Lung-MAP to patients. Faller, who is holder of the Alan P. Lyss Endowed Chair in Cancer Research at Missouri Baptist Medical Center, said it is important for patients in smaller community settings to be able to enroll in Lung-MAP “because that’s where most of the cancer care is delivered in this country.”
“Trials should be dynamic; they really shouldn’t be set in stone,” said investigator Paul Paik, MD, Clinical Director of the Thoracic Oncology Service at Memorial Sloan Kettering Cancer Center. As an example of how Lung-MAP’s screening helps patients, he cited the value of identifying patients with MET exon 14 skipping alterations—a driver mutation biomarker in NSCLC—so the patients can be treated with MET inhibitors.
During a panel discussion on amplifying patient voices, speakers emphasized the value of enrollment in clinical trials for lung cancer patients. “Clinical trials are part of clinical care in lung cancer,” said Andrea Ferris, President and CEO of LUNGevity. She said that trials are no longer a last resort, but over the last 10 to 15 years have evolved to the point where they are often the best treatment option for lung cancer patients. She added that there has been a mindset shift, and newer clinicians now think of clinical trials differently from physicians who went to medical school 30 years ago.
Kim Norris, co-founder of the Lung Cancer Foundation of America, agreed. She noted that in the last 10 to 15 years, clinical trials have become the gold standard of treatment. Norris said lung cancer advocates are now pushing states for mandated insurance coverage of biomarker testing, and education is needed in rural communities for both providers and patients on the value of genomic testing to identify the best treatment option for each lung cancer patient. “We need to go out into the community to educate the public,” she said, noting that barber shops, beauty salons, and faith-based organizations are good community venues for educating the public on the importance of biomarker testing and clinical trials for lung cancer. “You need to know what is unique about your tumor,” Norris said, because the more information the patient has, the better the outcome.
Marcia Horn, JD, Chair of MET Crusaders (representing lung cancer patients with MET alterations) and President and CEO of the International Cancer Advocacy Network, said that nothing could be more important than getting newly diagnosed lung cancer patients screened for actionable biomarkers, including MET alterations. She said stratification of patients by biomarker is vitally important to outcomes, and added that each lung cancer patient needs to be introduced to a biomarker support group with others who have the same mutation. “We’d love to see more decentralized trials,” she said, noting that they are so much more convenient for patients and their families. She stressed the need for collaboration and partnerships among all in the cancer research sector.
Lung-MAP began in 2014 as an umbrella trial that enrolled patients with advanced squamous-cell NSCLC. Beginning in 2019, the trial expanded to include patients with non-squamous cell NSCLC as well. During the trial’s first 10 years, nearly all genomic screening for assigning patients to Lung-MAP biomarker sub-studies was done using the Foundation Medicine genomic testing platform. Even though enrolled subjects in Lung-MAP 3.0 can now use previous genomic screening test results, genomic screening using the Foundation Medicine screening platform remains available to trial participants at no cost to them.
Peggy Eastman is a contributing writer.