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Collaborative Learning on TROP2 ADCs in NSCLC
Tailored Education on TROP-2‒Targeting ADCs in NSCLC: My Reflections on a Small-Group Collaborative Learning Experience

Released: February 29, 2024

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Key Takeaways
  • A series of small-group, collaborative learning experiences led by lung cancer experts was developed with a focus on the treatment of advanced NSCLC and potential integration of TROP-2‒targeting ADCs.
  • Edward B. Garon, MD, MS, reflects on his experience leading the initial collaborative learning experience “office hours.”

Datopotamab deruxtecan (Dato-DXd) and sacituzumab govitecan are TROP-2‒targeting antibody‒drug conjugates (ADCs) currently under investigation as both monotherapy and in combination with other agents for the treatment of advanced non-small-cell lung cancer (NSCLC) with or without actionable genomic alterations. After identifying interested healthcare professionals (HCPs) who treat patients with lung cancer, a group of lung cancer experts including myself led a series of collaborative learning experiences with approximately 10 community and academic medical oncologists per group, with a focus on the treatment of advanced NSCLC and potential integration of TROP-2‒targeting ADCs. Here, I reflect on my experience leading the initial collaborative learning experience “office hours” focused on TROP-2‒targeting ADCs for the treatment of advanced NSCLC.

In advance of the collaborative learning experience, participants completed a survey with cases and questions querying their management of patients with advanced NSCLC and adverse events with TROP-2‒targeting ADCs. The office hour then followed a case-based format using these cases and questions as the foundation for the discussion. I think that worked well for the HCPs, as that is how a patient case is approached: What treatment do you select to maximize efficacy, and how do you manage and mitigate potential toxicity? 

The same survey also was sent to a more global group.

Overall, it was a very interesting and nice experience to lead the first office hours session related to TROP-2‒targeting ADCs. It was very clear that HCPs within the community have a lot of questions related to the treatment of advanced NSCLC, which makes sense when you consider that the practice of oncology has become increasingly more complex over time with continual advances in care. There was great interest in asking questions, with some that were directly related to the content being presented and others that were potentially tangential but still within the field of management of patients with NSCLC. The HCPs clearly had a great deal of interest in obtaining advice and hearing from a medical oncologist who specializes in lung cancer. Whereas my practice is devoted entirely to lung cancer and I have a great deal of protected research time, it may be very trying to remain current for an HCP who is managing various oncologic and often hematologic conditions. There are many conditions and situations for which we do not have a perfect dataset, and I think the HCPs clearly were interested in getting their answers to these nuanced situations.

Particularly for this topic, which was TROP-2‒targeting ADCs that are not yet approved in this setting, a couple of unique issues arose related to the available evidence. There was one question regarding data that are available in a press release but not yet presented or published. It is difficult to comment on such data, but it is clear that HCPs are staying up to date on emerging evidence.

Another point came up integrating the phase III REVEL trial, which compared docetaxel with docetaxel plus ramucirumab as second-line treatment for patients with metastatic NSCLC. In this study, the combination of docetaxel plus ramucirumab demonstrated significantly improved progression-free survival and overall survival compared with docetaxel monotherapy. HCPs expressed frustration that in trials of Dato-DXd (for example, TROPION-Lung01), the comparator arm was single-agent docetaxel and not the combination with ramucirumab. Although the data with Dato-DXd are immature at this time, they are not suggestive of an overall survival benefit. So, for these HCPs who are using docetaxel plus ramucirumab, the available data did not necessarily answer their clinical questions regarding potential benefit of Dato-DXd versus their current standard. I think it was clear that these HCPs, despite having very busy practices, are staying up to date on current literature, and although they may have difficulty applying it in nuanced situations, they also are quite familiar with research developments, clinical trials, and even some of the issues with study design.

Regarding the pregroup survey on management of advanced NSCLC and adverse events with TROP-2‒targeting ADCs, it was interesting to note some differences between the small-group participants and the broader HCP group. Particularly, the responses were more varied among global respondents, which is not surprising given that an increased number of surveys were completed, and global HCPs were more likely to select Dato-DXd on clinical trial as the next line of therapy for the included cases compared with more established therapies, such as docetaxel plus ramucirumab.

Overall, it was certainly a very educational experience for me, and I believe for the HCPs who participated, as well. They seemed eager to hear the information on TROP-2‒targeting ADCs in advanced NSCLC and to discuss ways in which it could be applied to their own practice.

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How likely are you to incorporate TROP-2‒targeting ADCs into the treatment of your patients with advanced NSCLC, if approved? Answer the polling question and join the conversation in the discussion box below.

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If TROP-2–targeting ADCs are approved in the second-line setting for advanced NSCLC, how likely are you to incorporate this therapy into your clinical practice?

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