ASCO Lung Cancer 2022 – hybrid, Chicago
Lecture Board: Maximilian Hochmair, MD
Medical Writer: Judith Moser, MD
Publishing Editor: Anna Fenzl, PhD
Preface ASCO Lung Cancer 2022
After 2 years of virtual meetings in the midst of the COVID-19 pandemic, the Annual Meeting of the American Society of Clinical Oncology (ASCO) returned to its live format, as oncology experts from around the world gathered again in Chicago, USA, and virtually from 3rd–7th June 2022, to discuss the most exciting updates in the field of lung cancer.
Early-stage NSCLC: perioperative strategies and approaches in the unresectable
Neoadjuvant chemotherapy has been shown to significantly prolong overall survival (OS) in resectable non–small-cell lung cancer (NSCLC), although the absolute 5-year survival is improved by as little as 5 %. Similarly, pathological complete responses (pCR) are infrequently achieved; 15 trials investigating preoperative chemotherapy revealed an overall median rate of 4 %.
The clinical care pathways in early-stage lung cancer are changing
Many immunotherapies are being studied in the neoadjuvant or perioperative setting, but the only one that has been reported in a phase III trial as neoadjuvant treatment to date is nivolumab. There are three prospective trials that assessed nivolumab in the resectable setting. The NADIM I trial was a groundbreaking phase II study that looked at nivolumab plus chemotherapy followed by resection and demonstrated impressive results regarding pathologic endpoints and two-year survival.
Targeting KRASG12C, METex14, EGFR & ALK: new ways to further improve patient outcomes
KRASG12C mutations are found in approximately 14 % of patients with adenocarcinoma of the lung. Adagrasib, a covalent inhibitor of KRASG12C, has been developed to show a long half-life of 23 hours, dose-dependent pharmacokinetics, and CNS penetration. At ASCO 2020, Spira et al. reported data from a registrational phase II cohort of 116 patients with unresectable or metastatic, KRASG12C-mutated NSCLC included in the multi-cohort, phase I/II KRYSTAL-1 study.
Deeper insights into combinations of immune checkpoint inhibitors with other drug classes
Various regimens consisting of anti-PD-(L)1 antibodies with or without chemotherapy have been approved for the first-line treatment of patients with advanced NSCLC that does not harbor genomic alterations. The analysis reported at ASCO 2022 by Akinboro et al. used pooled data from 12 pivotal studies to compare overall survival (OS) obtained with chemoimmunotherapy (n = 455) vs. immunotherapy (n = 1,298) in patients with ALK- and EGFR-negative tumors that showed ≥ 50 % PD-L1 expression.
Extensive-stage small-cell lung cancer: successful and less successful combination strategies
n the first-line treatment of patients with extensive-stage small cell lung cancer (ES-SCLC), the IMpower133 and CASPIAN trials have established the anti-PD-L1 antibodies atezolizumab and durvalumab, respectively, as standard-of-care treatment in addition to platinum-etoposide. However, PD-L1 inhibitors can only prolong overall survival by approximately 2 months and disease progression eventually develops in most cases, which still implies a significant unmet need for new therapies to improve long-term outcomes.
EXPERT VIDEOS
All video interviews from ASCO 2022
John Varlotto summarizes the insights that have been obtained based on recent studies regarding immunotherapy plus chemoradiation in patients with unresectable, locally advanced stage III non-small cell lung cancer, explains the different effect observed with pembrolizumab and nivolumab and how these results compare to existing data. He cautions against using the impressive pathologic complete response rates with neoadjuvant chemoimmunotherapy to the unresectable setting due to the lack of long-term survival rates with neo-adjuvant chemo/immunotherapy and the impressive 47.5 median overall survival noted with concurrent chemo/radiotherapy followed by consolidative durvalumab in the Pacific Trial.
Jessica Donington highlights the most promising agents currently investigated in the neoadjuvant setting in patients with resectable NSCLC, how the “intensity” of neoadjuvant treatment affects the outcomes and discusses if neoadjuvant chemo-immunotherapy is the new standard of care. She outlines which variables related to surgery itself are determinants of the success of curative surgery and which biomarkers are on the rise to guide therapy.