Advances in Biomarker-Driven Therapy for Advanced NSCLC - Episode 6

Implications of the VISION Trial for Clinical Practice

Briana Contreras

Paul K. Paik, MD

Paul K. Paik, MD, discusses how the results of the VISION trial and the recent FDA approval of tepotinib will impact clinical practice.

Briana Contreras: What are the overall implications of the VISION trial for clinical practice?

Paul K. Paik, MD: Once the results of the VISION trial were released, particularly after tepotinib was FDA approved in January, the implication was that we had a new drug for patients with this kind of alteration. MET exon 14 skipping happens in 3% to 4% of our lung adenocarcinoma patients. It’s less common for patients with squamous cell lung cancers; it’s more common for patients with sarcomatoid carcinomas. It’s a brand-new drug, a targeted therapy, that we think is pretty effective and that we will be able to give to patients who are diagnosed with this. It will also add on to the armamentarium. For example, we can use it in addition to capmatinib, which was approved earlier this year, and crizotinib, which does not have an FDA-approved indication but is recommended by the NCCN [National Comprehensive Cancer Network] Guidelines.

Briana Contreras: How will you incorporate tepotinib into your treatment planning?

Paul K. Paik, MD: The incorporation of tepotinib into treatment planning has to do with some of the earlier questions about when we should do biomarker testing, because most of us will prescribe tepotinib or capmatinib at the time we identify this alteration. If we happen to find this alteration right at the beginning, when we’re trying to select that first treatment option for a patient, we’ll usually prescribe that right at the beginning. If we find that later, which sometimes happens, then we’ll prescribe it when a patient has progressed on their existing line of therapy. As to how to use tepotinib in comparison with capmatinib, at this point, from a pure data perspective, we don’t know. The 2 drugs have never been compared head-to-head. My own take, looking at the efficacy data for both, is that they’re more similar than they are different. It’s 1 of those things in which they are both good drugs, both are selective MET inhibitors, and both can be used to treat patients who have MET exon 14 skipping alterations.

Briana Contreras: Have you had experience with this regimen in your patients with advanced non–small cell lung cancer? If so, what was your experience like?

Paul K. Paik, MD: Oh, sure. We [at Memorial Sloan Kettering Cancer Center] were a participating center for the VISION trial, and so we have a good amount of experience giving tepotinib to this patient population. In general, it has been a good drug. All our patients who’ve been treated have had some degree of tumor shrinkage that’s quite durable. Many of these patients have been on drug for quite some time before it has lost its efficacy. In general, the drug has been very well tolerated by most of our patients. The primary adverse effect—the No. 1 adverse effect we see—is, of course, peripheral edema, and we must carefully manage how patients are doing. This is an older population, and edema can sometimes be more significant clinically for these patients than for our younger patients.

Transcript edited for clarity.