ISHL 2022 – hybrid, Cologne
Lecture Board: Heinz Ludwig, MD; Alison J. Moskowitz, MD; George Rassidakis, MD; Margaret A. Shipp, MD; Andrea Visentin, MD; Ioanna Xagoraris, 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.
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