ESMO 2023 Lung Cancer – Åslaug Helland

Åslaug Helland summarizes the results from the NIPU trial combining UV1 vaccination and immunotherapy in the setting of malignant mesothelioma. Furthermore, she explains how study designs might be modified to expand treatment options in personalized medicine and explains which data could potentially be used as external comparator arms where randomized controlled trials might be unethical, or no defined standard treatment and/or too small patient groups are available.

Here is the full ESMO 2023 Lung Cancer report.

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Immunotherapy combinations in advanced-stage disease

As is known, immune checkpoint inhibition plays only a limited role after failure of EGFR- or ALK-targeted treatment in patients with advanced NSCLC; this applies to both monotherapy and combinations with chemotherapy as demonstrated by the CheckMate 722 and KEYNOTE-789 trials.

EGFR-mutated NSCLC: practice-changing results and other notable findings

In the setting of EGFR-mutated NSCLC, the third-generation EGFR TKI osimer­tinib is the current first-line standard of care, although eventual progression is virtually inevitable. Secondary EGFR and MET alterations have been found to account for 25 % to 50 % of cases of resistance.

Innovative agents directed against RET, Trop-2, KRASG12C and HER2

The highly selective and potent RET kinase inhibitor selpercatinib has been implemented in the treatment of lung cancer harboring RET gene fusions. At the same time, the combination of platinum, pemetrexed and pembrolizumab is an established first-line standard of care for patients without EGFR or ALK alterations. The aim of the randomized, open-label, phase III LIBRETTO-431 study was to define the optimal first-line regimen for patients with RET-fusion–positive NSCLC.

ALK-targeted adjuvant treatment and perioperative immunotherapy

Approximately 30 % to 40 % of patients with non–small-cell lung cancer (NSCLC) are diagnosed with resectable disease. Depending on the stage, the risk of disease recurrence remains high in spite of treatment, which calls for more effective strategies. For patients with resectable ALK-positive NSCLC, the guidelines recommend adjuvant platinum-based chemotherapy, while immunotherapy is not recommended.

Preface – ESMO Lung Cancer 2023

It is a pleasure to present you the memo inOncology 2023. This time we report on the ESMO Congress held in Madrid, Spain, from 20th to 24th October 2023.  It was an outstanding scientific and educational event with more than 33,000 participants from 155 countries.