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Success in lung cancer niches will hinge on access to next-gen sequencing

New targeted RET, cMET and KRAS therapies are crushing SOC, but uptake could come down to NGS availability

New targeted lung cancer therapies against RET, KRAS and c-MET are all outperforming standard of care in the clinic, including checkpoint inhibitors. But whether these therapies see uptake will likely depend more on whether next-generation sequencing becomes embedded in routine care than the small differences between them.

Four of the therapies are poised to enter the market within the next year, targeting narrow slices of the non-small cell lung cancer (NSCLC) patient population not yet served by tumor-targeted agents.

Selpercatinib from Eli Lilly and Co. and pralsetinib from Blueprint Medicines Co. are both designed for RET fusion-positive tumors; Merck KGaA’s tepotinib and Novartis AG’s capmatinib target cMET-positive tumors. These mutations make up 2% and 3% of NSCLC patients, respectively.

A third drug class could be on the market within the next two years, targeting KRAS g12c mutated NSCLC, which accounts for about 13% of patients. Amgen Inc.’s AMG 510 is the only program that has read out. Competitor Mirati Therapeutics Inc. is set to announce data from MRTX849 next quarter.

The five programs with data have shown response rates ranging from 50% to 68%, a big jump from the 11%-33% typically seen with standard of care, which, in some cases, includes checkpoint inhibitors.

But given the small numbers of patients and no clear efficacy advantage within each class, the ability to gain a foothold will boil down to whether patients and their physicians are aware of the new treatment options and have access to the diagnostic tools.

“I believe that we’re reaching a tipping point in lung cancer.”

Gregory Friberg, Amgen

In clinical trials, eligible patients were identified for these

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