From the point of view of thoracic oncology, the 2017 ASCO Congress that took place from 2nd to 6th June, 2017, in Chicago, Illinois, offered no major highlights, but a range of interesting news. You will find a summary of selected presentations and posters in this issue of memo – inOncology that covers various targeted approaches as well as immunotherapy and mesothelioma.
Malignant pleural mesothelioma represents a difficult-to-treat entity
with a generally poor prognosis. The management of these patients used to be limited by a paucity of therapeutic options, but there have recently been considerable steps forward. Novel agents including the angiokinase inhibitor nintedanib and immune checkpoint inhibitors have been tested in mesothelioma patients with encouraging results, although further research efforts are required, and confirmatory clinical studies are ongoing.
Immunotherapy is an emerging standard in lung cancer management, which is corroborated by the trial updates presented at ASCO 2017, many revealing durable treatment benefit over extended periods. Moreover, checkpoint inhibitors are being assessed in areas of unmet need such as the neoadjuvant and post-progression settings. Another important topic, which is being tackled from various directions, is the identification of determinants of response and resistance to immunotherapy. Genomic markers of course have an important role here, but also other parameters such as tumour burden dynamics.
In the field of EGFR-targeted therapies, research is increasingly moving towards overcoming acquired resistance, which as a rule limits initial responses to tyrosine kinase inhibitors. Laboratory studies are elucidating molecular mechanisms of resistance to individual therapies. Treatment of early stage patients with EGFR-mutant lung cancer is still under study. The adjuvant use of firstgeneration EGFR tyrosine kinase inhibitors might be discussed in the future, and the first-line armamentarium will most likely be augmented by the addition of another agent.
New treatment standards have been defined for patients whose lung tumours show EML4-ALK rearrangement, while HER2-targeted treatments are currently subject to clinical research. An issue deserving particular attention is metastatic disease to the central nervous system, which poses a major challenge in the management of lung cancer patients. Drugs that can penetrate the bloodbrain barrier offer advantages, and the role of prophylactic cranial irradiation continues to be defined. Further evaluation
of modern treatment options in this indication is vital.
Anna Nowak, MBBS FRACP PhD School of Medicine and Pharmacology and National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Western Australia Department of Medical Oncology, Sir Charles Gairdner Hospital Perth, Western Australia, Australia
Anna Nowak, MBBS FRACP PhD