ASCO insight: Professor Heather Wakelee and Professor Tony Mok

Heather Wakelee: Hi, I’m Heather Wakelee from Stanford University, California, USA.

Tony Mok: And Professor Tony Mok from the Chinese University of Hong Kong.

Which innovation presented at ASCO are you most excited about, and how soon do you think it could impact everyday patients?

HW: I was really excited to see the Harmony 6 data with ivonescimab. We’ve seen a lot about that compound, but to see a definitive overall survival result was quite nice. Again, it was a squamous cell population, so not necessarily all of lung cancer, but an important subset where we haven’t really been able to bring in the VEGF component previously, so that was nice. It will be widely adopted in China where it’s already approved, and I think we’ll likely start seeing it globally. There will be some who want to see the more global data come out first, but I really doubt that we’ll see any differences in outcomes when we look into the study being conducted more globally.

TM: I have to apologize that I may have to gong my own gong. I still think that the current seven-year data is impactful. In a sense, in non-small cell lung cancer, this is the first subgroup where it demonstrates such a long progression for survival. Now, it’s not ‘innovation’ innovation, because it’s over seven years old. However, this drug has not been used as a first line across all patients. But with this impactful data, I think the doctor and the patient will reconsider.

 What practical steps can the oncology community take this year to bring care closer to underserved patients?

HW: One of the really important aspects of drug development is thinking about how we have access to people across multiple different health care systems. I think it’s really critical that we are doing the work early to understand how we can give the minimum dose that has the same efficacy. By doing that, we are going to make sure that we are bringing down toxicity. We need to do that without reducing efficacy, and that is the trick.

There’s actually been some really exciting work being done in India and other places, but they’re looking at bringing down the doses of the immune checkpoint inhibitors with some comparative data looking actually quite encouraging. And so those are the sorts of things we need to be pursuing, and we really need to be pursuing them early.

We actually had some data from ASCO this year where the dose moving forward was higher than necessarily what was seen in some of the earlier development where efficacy wasn’t that different. And so we need to avoid that trap of going to ‘higher is better.’ It’s not. The best dose is necessarily going to be what we can give it a minimum that’s going to really impact patients, bringing down costs, bringing down the toxicity. So we had a nice session at ASCO sort of going over some of that data and thinking about what we need to be doing globally to improve access by having lowest possible active doses.

TM: My apology again that I have to bring in a controversial topic. Now, we have seen a lot of new drug development from China, which we already seen some of the data is quite impactful. And then the cost of those drugs in China is actually not that high because of the government using the reimbursement system to control the price. But once the drug had to become international or they want to be international, they’re required to go through the FDA process, and that is very expensive. And after the process, the drug become expensive.

So now it becomes controversial: would the NMP approval be acceptable to some of the developing country? In that way, the drug can actually be cheaper than coming directly from China.