Highlights on lung cancer 3

Dr Charlotte De Bondt, thoracic oncologist at GZA Hospitals, Antwerp presents her selection of highlights from the rapid oral abstract session on lung cancer.

Dr Jonathan Spicer presented a four-year survival update from the Checkmate 816 trial, a landmark phase III RCT involving patients with resectable NSCLC. In this study, patients were randomized to receive neoadjuvant chemoimmunotherapy with nivolumab or chemotherapy alone, followed by surgery without adjuvant treatment. The EFS benefit observed in the trial was maintained. Notably, several important prognostic indicators were identified. Firstly, the attainment of a pCR remains a significant prognostic factor for OS. Patients in the chemoimmunotherapy arm who achieved a pCR demonstrated superior OS compared to those who did not. Secondly, the type of platinum compound used did not impact the observed benefit, as both cisplatin and carboplatin groups showed similar advantages. This finding is particularly relevant for patients with conditions such as neuropathy or diabetes, where cisplatin administration is less favorable. Lastly, the clearance of ctDNA before surgery was also identified as a crucial prognostic factor for OS.

A subgroup analysis of the N2 cohort from the AEGEAN trial, a phase III RCT investigating perioperative durvalumab in patients with resectable NSCLC, revealed that the addition of immunotherapy significantly improves EFS. This benefit was observed both in the N2 subgroup and the overall ITT population. While the EFS benefit in the durvalumab versus placebo arm was similar among patients with single- or multi-level N2 involvement, the pCR benefit was less pronounced in patients with multi-level N2 involvement.

Patient-reported outcomes from the KEYNOTE-671 trial were presented. The trial design is similar to the AEGEAN trial but utilised pembrolizumab instead of durvalumab. Patients completed the EORTC QLQ-C30 and QLQ-LC13 questionnaires. The responses remained stable between both treatment arms, indicating that the PFS benefit observed with pembrolizumab does not compromise QoL.

The optimal consolidation strategy for unresectable locally advanced ALK-positive NSCLC remains elusive. A retrospective analysis compared outcomes among patients receiving an ALK TKI, durvalumab, or observation after concurrent chemoradiation. Unsurprisingly, patients who received consolidation therapy with an ALK TKI demonstrated better outcomes than those who received durvalumab or were under observation.

Patients with SCLC often present with or develop brain metastases during the course of their disease. Tarlatamab, a bispecific T-cell engager immunotherapy has demonstrated durable responses and promising survival outcomes in patients with previously treated SCLC in the DeLLphi-301 study. Here, the efficacy and safety of tarlatamab in patients with baseline brain metastases were reported. Notably, there are indications of sustained responses in this patient population with previously treated SCLC and stable brain metastases. There is no observed increase in toxicity.