ESMO 2023 Lung Cancer – hybrid, Madrid
Lecture Board: Maximilian Hochmair, MD
Medical Writer: Judith Moser, MD
Publishing Editor: Anna Fenzl, PhD
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.
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.
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.
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.
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.
Small-cell lung cancer: insights and new treatment options centering around DLL3
The cell surface protein delta-like-ligand 3 (DLL3) is an emerging therapeutic target in neuroendocrine tumors and neuroendocrine carcinomas such as small-cell lung cancer (SCLC). Approximately 75 % of SCLCs express DLL3. Data reported at ESMO 2023 showed that high DLL3 expression is associated with poor overall survival, advanced pathological grade, and a distinct immune landscape across neuroendocrine neoplasms found in the lung, prostate, and bladder.
ESMO Lung Cancer 2023 EXPERT INTERVIEWS
James R. M. Black provides an overview of the potential of ctDNA in pre-operative disease stratification for early lung cancer by highlighting data from an ultra-sensitive and specific ctDNA approach. Considering the challenges of comprehensive tissue sampling and that subclones may evade tumor biopsy detection due to undersampling of metastatic sites at relapse, he finally discusses what insights ctDNA-based methods could provide into the process of metastasis spread.
Sebastian Kobold discusses the growing interest in using CAR-T cell therapy as an innovative approach to treat solid tumors in the future, as well as T cell receptor T cell therapy. Although there are still some hurdles to overcome, he discusses what remarkable developments can be expected in this field in the coming years.
Gerrina Ruiter explains the limitations of previous HER2 agents tested in solid tumors while highlighting the encouraging preliminary results of the BEAMION Lung-1 trial of zongertinib in HER2–mutant solid tumors. Lastly, she talks about the challenges of bispecific antibodies, which have recently shown robust efficacy in solid tumors.
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.
David C. Currow highlights the encouraging results of two Phase 3 randomized trials that investigated a ghrelin antagonist to combat cachexia in NSCLC patients. He also provides an overview of the recent advancements in integrating palliative care for cancer patients, and addresses the ongoing challenges that we still face in terms of end-of-life care in everyday practice.